1346232402 NPI number — MR. DAVID L ROUS PT OCS

Table of content: MR. DAVID L ROUS PT OCS (NPI 1346232402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346232402 NPI number — MR. DAVID L ROUS PT OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROUS
Provider First Name:
DAVID
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT OCS
Provider Gender Code:
M

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:
1346232402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 23RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93301-2306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-327-4357
Provider Business Mailing Address Fax Number:
661-327-2311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 GOSFORD RD
Provider Second Line Business Practice Location Address:
STE G
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93309-7694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-832-9737
Provider Business Practice Location Address Fax Number:
661-832-9738
Provider Enumeration Date:
08/16/2005

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: 225100000X , with the licence number:  19919 , 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: P00113631 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ21297Z . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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