1689868010 NPI number — PRIME HEALTHCARE PARADISE VALLEY HOSPITAL

Table of content: (NPI 1689868010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689868010 NPI number — PRIME HEALTHCARE PARADISE VALLEY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME HEALTHCARE PARADISE VALLEY HOSPITAL
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:
PRIME ALLY PROGRAM
Provider Other Organization Name Type Code:
3
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:
1689868010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 MOSS ST
Provider Second Line Business Mailing Address:
490 EMORY, IMPERIAL BEACH, CA. 91932
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91911-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-585-4228
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 RIMBEY AVENUE
Provider Second Line Business Practice Location Address:
CLASS ROOM #27
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92154-3099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-628-3541
Provider Business Practice Location Address Fax Number:
619-628-3589
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HANLY
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
619-470-4233

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  37JW , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 283Q00000X , with the licence number: 090000086 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 37JW . This is a "COUNTY OF SAN DIEGO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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