1649353319 NPI number — RINATA WAGLE MD

Table of content: RINATA WAGLE MD (NPI 1649353319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649353319 NPI number — RINATA WAGLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAGLE
Provider First Name:
RINATA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1649353319
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:
50 DOUGLAS DRIVE
Provider Second Line Business Mailing Address:
SUITE 391 HEALTH SERVICES ADMINISTRATION
Provider Business Mailing Address City Name:
MARTINEZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94553-4098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-957-5429
Provider Business Mailing Address Fax Number:
925-957-5401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 ALHAMBRA AVENUE
Provider Second Line Business Practice Location Address:
CONTRA COSTA REGIONAL MEDICAL CENTER AND HEALTH CENTERS
Provider Business Practice Location Address City Name:
MARTINEZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94553-3158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-370-5110
Provider Business Practice Location Address Fax Number:
925-370-5142
Provider Enumeration Date:
10/24/2006

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: 2084P0800X , with the licence number:  A80742 , 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)