1487980389 NPI number — VALLEY ORTHOPEDIC INSTITUTE INC

Table of content: (NPI 1487980389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487980389 NPI number — VALLEY ORTHOPEDIC INSTITUTE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY ORTHOPEDIC INSTITUTE 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:
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:
1487980389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
647 W AVENUE Q
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93551-3893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-949-8643
Provider Business Mailing Address Fax Number:
661-947-1631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1533 N DOWNS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-2456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-446-2900
Provider Business Practice Location Address Fax Number:
760-446-2910
Provider Enumeration Date:
10/27/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
MEHUL
Authorized Official Middle Name:
MAHENRA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
661-949-8643

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  A102466 , 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: 1205037561 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700087582 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".