1821100983 NPI number — DR. TABETHA RIDGWAY HARKEN MD, MPH

Table of content: DR. TABETHA RIDGWAY HARKEN MD, MPH (NPI 1821100983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821100983 NPI number — DR. TABETHA RIDGWAY HARKEN MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARKEN
Provider First Name:
TABETHA
Provider Middle Name:
RIDGWAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
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:
1821100983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 CITY DRIVE S.
Provider Second Line Business Mailing Address:
BUILDING 56 SUITE 800
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-3201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-456-6853
Provider Business Mailing Address Fax Number:
714-456-7180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S. MANCHESTER AVE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-2911
Provider Business Practice Location Address Fax Number:
714-456-8383
Provider Enumeration Date:
08/31/2006

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: 207V00000X , with the licence number:  A95354 , 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)





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