1154593234 NPI number — AMADOR COMMUNITY ACTION AGENCY

Table of content: REINA DEL CARMEN LOZA (NPI 1255778437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154593234 NPI number — AMADOR COMMUNITY ACTION AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMADOR COMMUNITY ACTION AGENCY
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:
1154593234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 HIGHWAY 49
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SONORA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95370-5666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-533-1397
Provider Business Mailing Address Fax Number:
209-533-9620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
147 NORTH HIGHWAY 49
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-533-1397
Provider Business Practice Location Address Fax Number:
209-533-9620
Provider Enumeration Date:
03/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LAGG
Authorized Official First Name:
LORI
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
FAMILY ADVOCATE
Authorized Official Telephone Number:
209-533-1397

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  4HIM287 , 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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