1902121429 NPI number — APRIL MANCUSO D.O.

Table of content: APRIL MANCUSO D.O. (NPI 1902121429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902121429 NPI number — APRIL MANCUSO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANCUSO
Provider First Name:
APRIL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYNOLDS
Provider Other First Name:
APRIL
Provider Other Middle Name:
MANCUSO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1902121429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1871 MARTIN AVE
Provider Second Line Business Mailing Address:
NMCI MEDICAL CLINIC, INC
Provider Business Mailing Address City Name:
SANTA CLARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-463-9234
Provider Business Mailing Address Fax Number:
408-988-8585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1871 MARTIN AVE
Provider Second Line Business Practice Location Address:
NMCI MEDICAL CLINIC, INC
Provider Business Practice Location Address City Name:
SANTA CLARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-463-9234
Provider Business Practice Location Address Fax Number:
408-988-8585
Provider Enumeration Date:
03/29/2010

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: 208100000X , with the licence number:  34010586 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 20A14006 , 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)