1154551026 NPI number — LEAH M. PIKE, M.D., PROFESSIONAL CORPORATION

Table of content: MR. NATHAN NORTHUP MO/HIS (NPI 1508206244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154551026 NPI number — LEAH M. PIKE, M.D., PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEAH M. PIKE, M.D., PROFESSIONAL CORPORATION
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:
KIDS PLACE ORTHOPEDICS
Provider Other Organization Name Type Code:
3
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:
1154551026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30525
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90853-0525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-936-9200
Provider Business Mailing Address Fax Number:
562-936-9201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3742 KATELLA AVE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-936-9200
Provider Business Practice Location Address Fax Number:
562-936-9201
Provider Enumeration Date:
07/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PIKE
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-936-9200

Provider Taxonomy Codes

  • Taxonomy code: 207XP3100X , with the licence number:  G83814 , 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)





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