1144365891 NPI number — MS. RITA DREADEN

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 1144365891 NPI number — MS. RITA DREADEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DREADEN
Provider First Name:
RITA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DREADEN
Provider Other First Name:
RITA
Provider Other Middle Name:
SOCORRO
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144365891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 11867
Provider Second Line Business Mailing Address:
CORRECTIONAL HEALTH DIVISION
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93775-1867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-445-3246
Provider Business Mailing Address Fax Number:
559-445-3370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 M ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93721-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-264-2700
Provider Business Practice Location Address Fax Number:
559-264-2767
Provider Enumeration Date:
02/20/2007

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: 163W00000X , with the licence number:  238207 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 1203 , 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)