1417075029 NPI number — CRIS ARMADA JR. D.O.INC.

Table of content: (NPI 1417075029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417075029 NPI number — CRIS ARMADA JR. D.O.INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRIS ARMADA JR. D.O.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:
ARMADA WELLNESS & FAMILY CARE
Provider Other Organization Name Type Code:
3
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:
1417075029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10399 LEMON AVE STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91737-3771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-373-0216
Provider Business Mailing Address Fax Number:
909-373-1902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10399 LEMON AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91737-3771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-373-0216
Provider Business Practice Location Address Fax Number:
909-373-1902
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARMADA
Authorized Official First Name:
CRIS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
909-373-0216

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20A5158 , 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: 1417075029 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00AX51580 . This is a "00AX51580" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ06898Z . This is a "MEDICARE GRP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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