1427120427 NPI number — DR. FRANCISCO M BACERDO DPM

Table of content: DR. FRANCISCO M BACERDO DPM (NPI 1427120427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427120427 NPI number — DR. FRANCISCO M BACERDO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BACERDO
Provider First Name:
FRANCISCO
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1427120427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1746
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98046-1746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-778-9115
Provider Business Mailing Address Fax Number:
425-771-9179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20006 CEDAR VALLEY RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-6334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-778-9115
Provider Business Practice Location Address Fax Number:
425-771-9179
Provider Enumeration Date:
11/14/2006

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: 213E00000X , with the licence number:  PO 00000526 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1095546 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".