1164768982 NPI number — O & D SURGICAL AND MEDICAL SOLUTIONS INC.

Table of content: (NPI 1164768982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164768982 NPI number — O & D SURGICAL AND MEDICAL SOLUTIONS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O & D SURGICAL AND MEDICAL SOLUTIONS INC.
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:
1164768982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 EAST GRAGER AVENUE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95350-4347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-589-1500
Provider Business Mailing Address Fax Number:
209-521-0813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 EAST GRAGER AVENUE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95350-4347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-589-1500
Provider Business Practice Location Address Fax Number:
209-521-0813
Provider Enumeration Date:
12/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DEL VALLE
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
JORGE
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
209-614-1445

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  A81970 , 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)





Copyright © 2007-2024 www.npivalidator.com