1255826038 NPI number — CAL MED VASCULAR CENTER LLC

Table of content: ANGELO L LABRINAKOS MS, PT, DPT, ATC (NPI 1265455307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255826038 NPI number — CAL MED VASCULAR CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAL MED VASCULAR CENTER LLC
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:
1255826038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 ALABAMA ST STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92373-8088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-580-3353
Provider Business Mailing Address Fax Number:
909-580-1363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1281 W C ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-580-3353
Provider Business Practice Location Address Fax Number:
909-580-1363
Provider Enumeration Date:
06/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MENDOZA
Authorized Official First Name:
OLIVIA
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
909-580-3353

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com