1245589316 NPI number — MR. LOGAN JAMES LINARES M.S., MFTI

Table of content: MR. LOGAN JAMES LINARES M.S., MFTI (NPI 1245589316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245589316 NPI number — MR. LOGAN JAMES LINARES M.S., MFTI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINARES
Provider First Name:
LOGAN
Provider Middle Name:
JAMES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S., MFTI
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINARES
Provider Other First Name:
LOGAN
Provider Other Middle Name:
JAMES
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S MFTI
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245589316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6615 VALLEY HI DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95823-7076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-681-6300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6615 VALLEY HI DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823-7076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-681-6300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2012

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: 106H00000X , with the licence number:  76065 , 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)