1962528489 NPI number — DR. STEPHEN AUGUST SOUZA RPT DPT

Table of content: DR. STEPHEN AUGUST SOUZA RPT DPT (NPI 1962528489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962528489 NPI number — DR. STEPHEN AUGUST SOUZA RPT DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUZA
Provider First Name:
STEPHEN
Provider Middle Name:
AUGUST
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
RPT DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOUZA
Provider Other First Name:
STEPHEN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPT INC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1962528489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23105 LA GRAN JA DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91354-2320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-297-6217
Provider Business Mailing Address Fax Number:
818-365-1259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14901 RINALDI ST
Provider Second Line Business Practice Location Address:
SUITE 335
Provider Business Practice Location Address City Name:
MISSION HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91345-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-365-9690
Provider Business Practice Location Address Fax Number:
818-365-9199
Provider Enumeration Date:
03/22/2007

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: 225100000X , with the licence number:  PT12097 , 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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