1053603795 NPI number — JOHN LINO GASPERONI, PH.D., PSYCHOLOGIST, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053603795 NPI number — JOHN LINO GASPERONI, PH.D., PSYCHOLOGIST, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN LINO GASPERONI, PH.D., PSYCHOLOGIST, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1053603795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3050 CITRUS CIR STE 202
Provider Second Line Business Mailing Address:
#202
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-2662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-279-1046
Provider Business Mailing Address Fax Number:
925-279-1146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3050 CITRUS CIR STE 202
Provider Second Line Business Practice Location Address:
#202
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-2662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-279-1046
Provider Business Practice Location Address Fax Number:
925-279-1146
Provider Enumeration Date:
05/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GASPERONI
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
LINO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
925-279-1046

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY 11734 , 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)





Copyright © 2007-2024 www.npivalidator.com