1225055916 NPI number — LALAINE GUEVARRA DIMAGIBA M.D.

Table of content: LALAINE GUEVARRA DIMAGIBA M.D. (NPI 1225055916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225055916 NPI number — LALAINE GUEVARRA DIMAGIBA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMAGIBA
Provider First Name:
LALAINE
Provider Middle Name:
GUEVARRA
Provider Name Prefix Text:
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:
DIMAGIBA-SEBASTIAN
Provider Other First Name:
LALAINE
Provider Other Middle Name:
GUEVARRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225055916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 254947
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95865-4947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-854-6975
Provider Business Mailing Address Fax Number:
916-854-6844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 CALIFORNIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94118-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-600-6565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2006

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: 208000000X , with the licence number:  C51599 , 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)