1205187218 NPI number — APEX PROSTHETICS INSTITUTE OF SAN DIEGO

Table of content: (NPI 1205187218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205187218 NPI number — APEX PROSTHETICS INSTITUTE OF SAN DIEGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEX PROSTHETICS INSTITUTE OF SAN DIEGO
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:
1205187218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3585 5TH AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-5081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-501-5383
Provider Business Mailing Address Fax Number:
619-501-5390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3585 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-5081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-501-5383
Provider Business Practice Location Address Fax Number:
619-501-5390
Provider Enumeration Date:
10/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MOCK
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PROSTHETIST
Authorized Official Telephone Number:
619-501-5383

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  CP003901 , 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