1225319478 NPI number — FRANCISCO T PIMENTEL P.T.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225319478 NPI number — FRANCISCO T PIMENTEL P.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIMENTEL
Provider First Name:
FRANCISCO
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.A.
Provider Gender Code:
M

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:
1225319478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 HEFFERNAN AVE
Provider Second Line Business Mailing Address:
STE 2-B
Provider Business Mailing Address City Name:
CALEXICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92231-4718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-768-4100
Provider Business Mailing Address Fax Number:
760-768-6900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 HEFFERNAN AVE
Provider Second Line Business Practice Location Address:
STE 2-B
Provider Business Practice Location Address City Name:
CALEXICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92231-4718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-768-4100
Provider Business Practice Location Address Fax Number:
760-768-6900
Provider Enumeration Date:
09/01/2011

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: 225200000X , with the licence number:  AT 3780 , 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: AT 3780 . This is a "STATE OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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