1063469005 NPI number — DR. DORA BURCHETTE NORRIS MD

Table of content: DR. DORA BURCHETTE NORRIS MD (NPI 1063469005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063469005 NPI number — DR. DORA BURCHETTE NORRIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORRIS
Provider First Name:
DORA
Provider Middle Name:
BURCHETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURCHETTE
Provider Other First Name:
DORA
Provider Other Middle Name:
MARIA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063469005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39115 TRADE CENTER DR STE 130
Provider Second Line Business Mailing Address:
SIERRA MEDICAL GROUP
Provider Business Mailing Address City Name:
PALMDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93551-3649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-273-0100
Provider Business Mailing Address Fax Number:
661-273-5812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39115 TRADE CENTER DR STE 130
Provider Second Line Business Practice Location Address:
SIERRA MEDICAL GROUP
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-3649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-273-0100
Provider Business Practice Location Address Fax Number:
661-273-5812
Provider Enumeration Date:
05/27/2006

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: 208000000X , with the licence number:  G55748 , 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: 00G557480 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com