1851498133 NPI number — MARINELLI & FELDMAN MDS

Table of content: (NPI 1851498133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851498133 NPI number — MARINELLI & FELDMAN MDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARINELLI & FELDMAN MDS
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:
1851498133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1915 SUNNY CREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92835-3626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-879-2410
Provider Business Mailing Address Fax Number:
714-879-5340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1915 SUNNY CREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92835-3626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-879-2410
Provider Business Practice Location Address Fax Number:
714-879-5340
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REYES
Authorized Official First Name:
ANGELICA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
714-879-2410

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  G59971 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208800000X , with the licence number: A79874 , 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: 05D0684380 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G41816 . This is a "MEDI CAL RENDERING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G59971 . This is a "MEDI-CAL RENDERING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0011581 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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