1083602122 NPI number — WILLITS HOSPITAL INC.

Table of content: BLANDINE VARGAS DEL ROSARIO (NPI 1154714087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083602122 NPI number — WILLITS HOSPITAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLITS HOSPITAL 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:
ADVENTIST HEALTH HOWARD MEMORIAL
Provider Other Organization Name Type Code:
3
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:
1083602122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 888828
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90088-8828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-459-6801
Provider Business Mailing Address Fax Number:
707-459-9486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MARCELA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLITS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95490-5769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-459-6801
Provider Business Practice Location Address Fax Number:
707-459-9486
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOWE
Authorized Official First Name:
JUDSON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
707-456-3010

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  110000013 , 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)





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