1043415169 NPI number — MOIRA B FLANAGAN PHD

Table of content: MOIRA B FLANAGAN PHD (NPI 1043415169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043415169 NPI number — MOIRA B FLANAGAN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLANAGAN
Provider First Name:
MOIRA
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1043415169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 FST
Provider Second Line Business Mailing Address:
#76
Provider Business Mailing Address City Name:
DAVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-668-8988
Provider Business Mailing Address Fax Number:
530-668-1229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 MORSE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-973-6847
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2007

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: 246ZE0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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