1134583594 NPI number — CAREMERIDIAN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134583594 NPI number — CAREMERIDIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREMERIDIAN
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:
6
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:
1134583594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
163 TECHNOLOGY DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-2486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-794-0787
Provider Business Mailing Address Fax Number:
949-261-0457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1733 E ALLUVIAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-299-1200
Provider Business Practice Location Address Fax Number:
559-299-7800
Provider Enumeration Date:
04/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SHEA
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
949-688-5251

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  5500002963 , 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)

  • Identifier: 5500002963 . This is a "CDPH LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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