1306179577 NPI number — CORE CARE PEDIATRIC THERAPY INC.

Table of content: (NPI 1306179577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306179577 NPI number — CORE CARE PEDIATRIC THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORE CARE PEDIATRIC THERAPY INC.
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:
1306179577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3612 BARHAM BLVD
Provider Second Line Business Mailing Address:
W301
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90068-1142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-353-9196
Provider Business Mailing Address Fax Number:
323-798-4168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 1007
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-353-9196
Provider Business Practice Location Address Fax Number:
323-798-4168
Provider Enumeration Date:
09/04/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUOBADIA
Authorized Official First Name:
ESEOSA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER/ DIRECTOR OF SERVICES
Authorized Official Telephone Number:
213-353-9196

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  33449 , 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)