1083930788 NPI number — INTERIM, INCORPORATED

Table of content: DR. LAURA CATHERINE DUNN DO (NPI 1437324647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083930788 NPI number — INTERIM, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM, INCORPORATED
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:
INTERIM SANDY SHORES
Provider Other Organization Name Type Code:
3
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:
1083930788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
604 PEARL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-3070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-649-4522
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2982 BAYONET CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARINA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93933-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-649-4522
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
QUITON
Authorized Official First Name:
RHIYAN
Authorized Official Middle Name:
ARAFILES
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
831-649-4522

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 27582 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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