1174771307 NPI number — MRS. CATALINA MARTINEZ MANN ADC

Table of content: MRS. CATALINA MARTINEZ MANN ADC (NPI 1174771307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174771307 NPI number — MRS. CATALINA MARTINEZ MANN ADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANN
Provider First Name:
CATALINA
Provider Middle Name:
MARTINEZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ADC
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:
1174771307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7993 SIERRA AVENUE SUITE K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FONTANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92376-2850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-822-8720
Provider Business Mailing Address Fax Number:
909-822-8438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7993 SIERRA AVE
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92336-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-822-8720
Provider Business Practice Location Address Fax Number:
909-822-8438
Provider Enumeration Date:
08/29/2008

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: 171M00000X , with the licence number:  2464060 , 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)

  • Identifier: 4757 . This is a "TEMPORARY PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".