1093791188 NPI number — CONTRA COSTA EYE MEDICAL CENTER INC

Table of content: DARLA SUZANNE PORTER FNP (NPI 1659401784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093791188 NPI number — CONTRA COSTA EYE MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONTRA COSTA EYE MEDICAL CENTER 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:
DEGNAN EYE CENTER
Provider Other Organization Name Type Code:
4
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:
1093791188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 EAST ST
Provider Second Line Business Mailing Address:
STE 365
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94520-2056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-687-8280
Provider Business Mailing Address Fax Number:
925-687-9744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 EAST ST
Provider Second Line Business Practice Location Address:
STE 365
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94520-2056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-687-8280
Provider Business Practice Location Address Fax Number:
925-687-9744
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KINDY-DEGNAN
Authorized Official First Name:
NADINE
Authorized Official Middle Name:
AXEXANDRA
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
925-687-8280

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com