1346317377 NPI number — MISS JOYCE MARCY KURTZ SP

Table of content: MISS JOYCE MARCY KURTZ SP (NPI 1346317377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346317377 NPI number — MISS JOYCE MARCY KURTZ SP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURTZ
Provider First Name:
JOYCE
Provider Middle Name:
MARCY
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
SP
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:
1346317377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 BRISTOL ST
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
COSTA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92626-1808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-557-9292
Provider Business Mailing Address Fax Number:
714-557-9137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 BRISTOL ST
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
COSTA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92626-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-557-9292
Provider Business Practice Location Address Fax Number:
714-557-9137
Provider Enumeration Date:
11/28/2006

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: 235Z00000X , with the licence number:  SP 12754 , 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: SP 12754 . This is a "SP LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com