1245442888 NPI number — MRS. SANDY BELLER CANOUT O.T.,P.T.,C.F.P.,CHT

Table of content: VLADIMIR GORDIN D.C. (NPI 1861452856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245442888 NPI number — MRS. SANDY BELLER CANOUT O.T.,P.T.,C.F.P.,CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANOUT
Provider First Name:
SANDY
Provider Middle Name:
BELLER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.T.,P.T.,C.F.P.,CHT
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:
1245442888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3638 LEWIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90807-4118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-426-9797
Provider Business Mailing Address Fax Number:
213-481-1518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90017-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-481-1515
Provider Business Practice Location Address Fax Number:
213-481-1518
Provider Enumeration Date:
05/04/2007

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: 174400000X , with the licence number:  PT12641 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: OT6574 , 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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