1093791667 NPI number — RENITA JEJUAN PULLENS D.O.

Table of content: MELANIE NICHOLS (NPI 1598900862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093791667 NPI number — RENITA JEJUAN PULLENS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PULLENS
Provider First Name:
RENITA
Provider Middle Name:
JEJUAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1093791667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23622 CALABASAS RD
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
CALABASAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91302-1549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-591-3435
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15315 MAGNOLIA BLVD.
Provider Second Line Business Practice Location Address:
ROZE ROOM HOSPICE OF THE VALLEY
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-783-1002
Provider Business Practice Location Address Fax Number:
818-783-1066
Provider Enumeration Date:
12/15/2005

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: 208D00000X , with the licence number:  20A8326 , 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)