1841223021 NPI number — GENERATION II USA INC

Table of content: (NPI 1841223021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841223021 NPI number — GENERATION II USA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERATION II USA 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:
1841223021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27412 ALISO VIEJO PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALISO VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92656-3371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-362-3883
Provider Business Mailing Address Fax Number:
949-349-0026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27412 ALISO VIEJO PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALISO VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92656-5337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-362-3883
Provider Business Practice Location Address Fax Number:
949-349-0026
Provider Enumeration Date:
07/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EMERY
Authorized Official First Name:
MARK
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
949-362-3883

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0151713 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54559 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90042680 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9518606 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".