1184655417 NPI number — TENET HEALTHSYSTEM NORRIS, INC.

Table of content: PAULETTE ANN MARTIN CRNA (NPI 1093762072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184655417 NPI number — TENET HEALTHSYSTEM NORRIS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENET HEALTHSYSTEM NORRIS, 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:
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:
1184655417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 57514
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-300-4122
Provider Business Mailing Address Fax Number:
323-865-0960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 EASTLAKE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-865-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMIN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VP OF GOVT PROGRAMS, TENET
Authorized Official Telephone Number:
310-775-8043

Provider Taxonomy Codes

  • Taxonomy code: 284300000X , with the licence number:  930000267 , 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)

  • Identifier: 0006159240 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSC30660F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050660 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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