1164877213 NPI number — MRS. JOVANA LYNN FORSYTHE CADC II

Table of content: MRS. JOVANA LYNN FORSYTHE CADC II (NPI 1164877213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164877213 NPI number — MRS. JOVANA LYNN FORSYTHE CADC II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORSYTHE
Provider First Name:
JOVANA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CADC II
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURDICK
Provider Other First Name:
JOVANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RADT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164877213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93385-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-869-1795
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2920 H ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93301-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-237-8200
Provider Business Practice Location Address Fax Number:
661-325-3929
Provider Enumeration Date:
04/26/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  R1228690416 , 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)