1386758894 NPI number — MS. JUDY CARMEN GARDNER CNS

Table of content: MS. JUDY CARMEN GARDNER CNS (NPI 1386758894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386758894 NPI number — MS. JUDY CARMEN GARDNER CNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDNER
Provider First Name:
JUDY
Provider Middle Name:
CARMEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNS
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:
1386758894
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:
443 VERONA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94526-2411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-838-5492
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 MUIR ROAD
Provider Second Line Business Practice Location Address:
NORTHERN CALIFORNIA HEALTH CARE SYSTEM
Provider Business Practice Location Address City Name:
MARTINEZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-372-2000
Provider Business Practice Location Address Fax Number:
925-372-2830
Provider Enumeration Date:
08/19/2006

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: 163WP0809X , with the licence number:  239080 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 364SP0809X , with the licence number: CERTIFICATE #16 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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