1982984506 NPI number — MRS. NAOMI LORRAINE MORAN M.A.

Table of content: MRS. NAOMI LORRAINE MORAN M.A. (NPI 1982984506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982984506 NPI number — MRS. NAOMI LORRAINE MORAN M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAN
Provider First Name:
NAOMI
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACKSON
Provider Other First Name:
NAOMI
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982984506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 SCENIC RIVER LN
Provider Second Line Business Mailing Address:
APT. 4C
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93308-7504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-437-2386
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1331 W AVENUE J
Provider Second Line Business Practice Location Address:
STE. 202
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-940-9094
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2011

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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