1336176239 NPI number — DR. ANNETTE M SWAIN PHD

Table of content: DR. ANNETTE M SWAIN PHD (NPI 1336176239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336176239 NPI number — DR. ANNETTE M SWAIN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAIN
Provider First Name:
ANNETTE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1336176239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15928 VENTURA BLVD
Provider Second Line Business Mailing Address:
#231
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91436-4401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-385-0913
Provider Business Mailing Address Fax Number:
818-385-1746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15928 VENTURA BLVD
Provider Second Line Business Practice Location Address:
#231
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-385-0913
Provider Business Practice Location Address Fax Number:
818-385-1746
Provider Enumeration Date:
06/27/2006

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: 103G00000X , with the licence number:  16330 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TA0700X , with the licence number: 16330 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 16330 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)