1619129178 NPI number — MRS. THERESA ANN VINCENT N.P.

Table of content: MRS. THERESA ANN VINCENT N.P. (NPI 1619129178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619129178 NPI number — MRS. THERESA ANN VINCENT N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VINCENT
Provider First Name:
THERESA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARMIJO
Provider Other First Name:
THERESA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619129178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18126 MUIR WOODS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-5937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-594-3887
Provider Business Mailing Address Fax Number:
714-534-3887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18126 MUIR WOODS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-594-3887
Provider Business Practice Location Address Fax Number:
714-534-3887
Provider Enumeration Date:
10/15/2008

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: 363LP0808X , with the licence number:  7763 , 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)