1114212685 NPI number — CITRUS VALLEY PHYSICIANS GROUP

Table of content: CHRISTINA MARIE COLLINS PHARM.D. (NPI 1275646622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114212685 NPI number — CITRUS VALLEY PHYSICIANS GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITRUS VALLEY PHYSICIANS GROUP
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:
1114212685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 CORPORATE PARK
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92606-5137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-474-6999
Provider Business Mailing Address Fax Number:
949-474-6997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 CORPORATE PARK
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92606-5137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-474-6999
Provider Business Practice Location Address Fax Number:
949-474-6997
Provider Enumeration Date:
06/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RAO
Authorized Official First Name:
RAJESH
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE ASSISTANT
Authorized Official Telephone Number:
949-474-6999

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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