1083717607 NPI number — VALPONI&WAGNER PHYSICAL THERAPY, INC

Table of content: LORENA LOSOYA B.S (NPI 1356638423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083717607 NPI number — VALPONI&WAGNER PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALPONI&WAGNER PHYSICAL THERAPY, 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:
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:
1083717607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 ESPLANADE
Provider Second Line Business Mailing Address:
#8
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95926-3366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-894-0221
Provider Business Mailing Address Fax Number:
530-894-0285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 ESPLANADE
Provider Second Line Business Practice Location Address:
#8
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-894-0221
Provider Business Practice Location Address Fax Number:
530-894-0285
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
530-894-0221

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PT0101350 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 697197 . This is a "ACN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: OPT101350 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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