1003995101 NPI number — EMG

Table of content: LAURA DEAN ALBUJA MSN ARNP (NPI 1497032155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003995101 NPI number — EMG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMG
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:
1003995101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10225 AUSTIN DR
Provider Second Line Business Mailing Address:
STE #103
Provider Business Mailing Address City Name:
SPRING VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91978-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-660-6719
Provider Business Mailing Address Fax Number:
619-660-5934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10225 AUSTIN DR
Provider Second Line Business Practice Location Address:
STE #103
Provider Business Practice Location Address City Name:
SPRING VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91978-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-660-6719
Provider Business Practice Location Address Fax Number:
619-660-5934
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WINEGAR
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
619-444-7454

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  16585 , 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)

  • Identifier: W11716 . This is a "MEDICARE CROUP #" identifier . This identifiers is of the category "OTHER".




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