1073669511 NPI number — MR. ELLIOTT P MIKE PMT

Table of content: MISS KIMBERLY NARAINE LCSW (NPI 1568868016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073669511 NPI number — MR. ELLIOTT P MIKE PMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIKE
Provider First Name:
ELLIOTT
Provider Middle Name:
P
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PMT
Provider Gender Code:
M

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:
1073669511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COMDT CG-1122 US COAST GUARD
Provider Second Line Business Mailing Address:
2100 2ND ST SW, SUITE 5314
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20593-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-437-6641
Provider Business Mailing Address Fax Number:
510-437-3943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 EAGLE RD
Provider Second Line Business Practice Location Address:
CG ISLAND
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-437-6641
Provider Business Practice Location Address Fax Number:
510-437-3943
Provider Enumeration Date:
01/26/2007

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: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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