1851378392 NPI number — SCOTT ALAN ENGWALL MD

Table of content: SCOTT ALAN ENGWALL MD (NPI 1851378392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851378392 NPI number — SCOTT ALAN ENGWALL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGWALL
Provider First Name:
SCOTT
Provider Middle Name:
ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1851378392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 54330
Provider Second Line Business Mailing Address:
UNV ANESTHESIA ASSOCIATES
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90054-0330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-456-6369
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 THE CITY DRIVE SOUTH
Provider Second Line Business Practice Location Address:
UCI MEDICAL CENTER
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-8978
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2005

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: 207L00000X , with the licence number:  G64211 , 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: 00G642110 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G642110 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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