1184940678 NPI number — DR. ELLEN CAYMAN PACSON M.D.

Table of content: DR. ELLEN CAYMAN PACSON M.D. (NPI 1184940678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184940678 NPI number — DR. ELLEN CAYMAN PACSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACSON
Provider First Name:
ELLEN
Provider Middle Name:
CAYMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1184940678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2055 KELLOGG AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92879-3111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-984-7483
Provider Business Mailing Address Fax Number:
951-600-3469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10800 MAGNOLIA AVEBUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92505-9288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-353-4619
Provider Business Practice Location Address Fax Number:
951-353-5838
Provider Enumeration Date:
04/09/2010

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A123136 , 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)