1578619813 NPI number — SUSAN ALZINA MERICA-JONES MSN CNM

Table of content: SUSAN ALZINA MERICA-JONES MSN CNM (NPI 1578619813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578619813 NPI number — SUSAN ALZINA MERICA-JONES MSN CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERICA-JONES
Provider First Name:
SUSAN
Provider Middle Name:
ALZINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN CNM
Provider Gender Code:
F

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:
1578619813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15351 ISLA VISTA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMUL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91935-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-669-3606
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 GROSSMONT CENTER DR
Provider Second Line Business Practice Location Address:
SHARP GROSSMONT HOSPITAL WOMEN'S CENTER PRENATAL CLINIC
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-740-4721
Provider Business Practice Location Address Fax Number:
619-740-4971
Provider Enumeration Date:
01/27/2007

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: 163W00000X , with the licence number:  336339 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LX0001X , with the licence number: 5142 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 367A00000X , with the licence number: NMW 7550 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: NMW007550 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".