1275539454 NPI number — MEK ARDEN, LLC

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 1275539454 NPI number — MEK ARDEN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEK ARDEN, 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:
6
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:
1275539454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1506 S. GLENDALE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-247-6200
Provider Business Mailing Address Fax Number:
818-247-6213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 ALTA ARDEN EXPY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-481-5500
Provider Business Practice Location Address Fax Number:
916-481-9845
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PEDRAJA
Authorized Official First Name:
FERNAN
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL CONTROLLER
Authorized Official Telephone Number:
818-247-6200

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 100000009 , 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: ZZR05855J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05D0704663 . This is a "CLIA ID NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 4279830001 . This is a "DME POS NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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