1205102324 NPI number — CARLEE MICHELE MOTOSHIGE M.A. SLP

Table of content: CARLEE MICHELE MOTOSHIGE M.A. SLP (NPI 1205102324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205102324 NPI number — CARLEE MICHELE MOTOSHIGE M.A. SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOTOSHIGE
Provider First Name:
CARLEE
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A. SLP
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:
1205102324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2960 CHAMPION WAY
Provider Second Line Business Mailing Address:
UNIT 410
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92782-1242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30252 TOMAS
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
RANCHO SANTA MARGARITA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92688-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-459-1658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2012

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: 235Z00000X , with the licence number:  SP7152 , 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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