1740492750 NPI number — DR. RITA CASSIA SAMPAIO PH.D.

Table of content: DR. RITA CASSIA SAMPAIO PH.D. (NPI 1740492750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740492750 NPI number — DR. RITA CASSIA SAMPAIO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMPAIO
Provider First Name:
RITA
Provider Middle Name:
CASSIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAMPAEO-SHAIN
Provider Other First Name:
RITA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740492750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 LUCILLE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94563-3705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-295-4145
Provider Business Mailing Address Fax Number:
925-925-5226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 LUCILLE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94563-3705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-295-4145
Provider Business Practice Location Address Fax Number:
925-925-5226
Provider Enumeration Date:
05/03/2007

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: 103TB0200X , with the licence number:  PSY 18107 , 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)

  • Identifier: 5877365 . This is a "KAISER MEDICAL RECORD NUMBER" identifier . This identifiers is of the category "OTHER".




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