1023258910 NPI number — MRS. RANDI V PILON OTR/L, CHT

Table of content: MRS. RANDI V PILON OTR/L, CHT (NPI 1023258910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023258910 NPI number — MRS. RANDI V PILON OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PILON
Provider First Name:
RANDI
Provider Middle Name:
V
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023258910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4148 W DELTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93291-4054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-372-7171
Provider Business Mailing Address Fax Number:
559-627-3284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1827 S COURT ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93277-5469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-627-3274
Provider Business Practice Location Address Fax Number:
559-627-3284
Provider Enumeration Date:
03/04/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  OT 8548 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)