1164544110 NPI number — HICKORY PINE ASSOCIATES

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 1164544110 NPI number — HICKORY PINE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HICKORY PINE ASSOCIATES
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:
HICKORY HOUSE
Provider Other Organization Name Type Code:
5
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:
1164544110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3141
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93011-3141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-484-1115
Provider Business Mailing Address Fax Number:
508-484-9038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93010-7922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-484-1115
Provider Business Practice Location Address Fax Number:
805-484-9038
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRINIDAD
Authorized Official First Name:
AMY
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
EXEC DIR OPERATIONS
Authorized Official Telephone Number:
805-484-1115

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , 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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