1184905028 NPI number — JEANNE MACAIRAN M.A., B.C.B.A.

Table of content: JEANNE MACAIRAN M.A., B.C.B.A. (NPI 1184905028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184905028 NPI number — JEANNE MACAIRAN M.A., B.C.B.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACAIRAN
Provider First Name:
JEANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., B.C.B.A.
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:
1184905028
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4675 STEVENS CREEK BLVD
Provider Second Line Business Mailing Address:
STE. 230
Provider Business Mailing Address City Name:
SANTA CLARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95051-6759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-423-8076
Provider Business Mailing Address Fax Number:
408-423-8077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4675 STEVENS CREEK BLVD
Provider Second Line Business Practice Location Address:
STE. 230
Provider Business Practice Location Address City Name:
SANTA CLARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95051-6759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-423-8076
Provider Business Practice Location Address Fax Number:
408-423-8077
Provider Enumeration Date:
09/06/2011

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: 103K00000X , with the licence number:  1-11-8829 , 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)





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