1659566917 NPI number — B TED FIELD MD INC

Table of content: (NPI 1659566917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659566917 NPI number — B TED FIELD MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B TED FIELD MD 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:
1659566917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1809 E DYER RD
Provider Second Line Business Mailing Address:
SUITE 311
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92705-5740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-863-0022
Provider Business Mailing Address Fax Number:
949-863-0023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1809 E DYER RD
Provider Second Line Business Practice Location Address:
SUITE 311
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-5740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-863-0022
Provider Business Practice Location Address Fax Number:
949-863-0023
Provider Enumeration Date:
09/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FIELD
Authorized Official First Name:
BYRON
Authorized Official Middle Name:
TED
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-744-3443

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G54069 , 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)