1457421976 NPI number — REBECCA KAY PIASENTIN REBECCA PIASENTIN

Table of content: REBECCA KAY PIASENTIN REBECCA PIASENTIN (NPI 1457421976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457421976 NPI number — REBECCA KAY PIASENTIN REBECCA PIASENTIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIASENTIN
Provider First Name:
REBECCA
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REBECCA PIASENTIN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRINCE-PIASENTIN
Provider Other First Name:
REBECCA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.F.T.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1457421976
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:
260 MAPLE CT
Provider Second Line Business Mailing Address:
SUITE 252
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93003-3516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-658-3725
Provider Business Mailing Address Fax Number:
805-654-9398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 MAPLE CT
Provider Second Line Business Practice Location Address:
SUITE 252
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-658-3725
Provider Business Practice Location Address Fax Number:
805-654-9398
Provider Enumeration Date:
11/09/2006

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: 101YM0800X , with the licence number:  MFC36171 , 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)





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