1255731428 NPI number — FOUNTIAN VALLEY REGIONAL MEDICAL CENTER

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 1255731428 NPI number — FOUNTIAN VALLEY REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUNTIAN VALLEY REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1255731428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21136 SUNWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91789-3317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-598-9908
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17100 EUCLID ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-966-8128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
YOUNGHI
Authorized Official Middle Name:
Authorized Official Title or Position:
RNFA
Authorized Official Telephone Number:
714-966-8128

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  364193 , 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)





Copyright © 2007-2026 www.npivalidator.com