1003073156 NPI number — AEFCT

Table of content: (NPI 1003073156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003073156 NPI number — AEFCT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AEFCT
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:
1003073156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4669 MURPHY CANYON RD STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-4333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-569-0056
Provider Business Mailing Address Fax Number:
858-569-4233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4669 MURPHY CANYON RD STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-4333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-569-0056
Provider Business Practice Location Address Fax Number:
858-569-4233
Provider Enumeration Date:
05/16/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
VUONG (MARYANN)
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
858-569-0056

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1588803696 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1609384064 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1639508179 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003073156 . This is a "AEFCT NPI#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1194233569 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1104208438 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1730328840 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".