1508954272 NPI number — DR. JARED P HJELMSTAD DC

Table of content: DR. JARED P HJELMSTAD DC (NPI 1508954272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508954272 NPI number — DR. JARED P HJELMSTAD DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HJELMSTAD
Provider First Name:
JARED
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1508954272
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:
29377 RANCHO CALIFORNIA RD
Provider Second Line Business Mailing Address:
#106
Provider Business Mailing Address City Name:
TEMECULA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-676-8686
Provider Business Mailing Address Fax Number:
951-676-5158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29377 RANCHO CALIFORNIA RD
Provider Second Line Business Practice Location Address:
#106
Provider Business Practice Location Address City Name:
TEMECULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-676-8686
Provider Business Practice Location Address Fax Number:
951-676-5158
Provider Enumeration Date:
10/10/2006

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: 111N00000X , with the licence number:  DC22006 , 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: 22006 . This is a "STATE LIC NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC0220060 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC0220060 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".