1063640597 NPI number — UNITED FAMILY MEDICAL SUPPLY, INC.

Table of content: STACI MARIE FARLEY LPC (NPI 1275938524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063640597 NPI number — UNITED FAMILY MEDICAL SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED FAMILY MEDICAL SUPPLY, INC.
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:
6
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:
1063640597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2836 E COGHILL TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94568-1189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-673-1785
Provider Business Mailing Address Fax Number:
925-828-2088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20524 WISTERIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTRO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94546-5523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-727-9169
Provider Business Practice Location Address Fax Number:
510-727-9176
Provider Enumeration Date:
06/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TABURAZA
Authorized Official First Name:
JULIANA
Authorized Official Middle Name:
ULEP
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
510-673-1785

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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