1285708719 NPI number — RECOMBI INC

Table of content: DR. STEPHEN TODD OLEX M.D. (NPI 1013114461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285708719 NPI number — RECOMBI INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOMBI INC
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:
1285708719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 N WESTLAKE BLVD
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
WESTLAKE VILLAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91362-3700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 N WESTLAKE BLVD
Provider Second Line Business Practice Location Address:
STE 250
Provider Business Practice Location Address City Name:
WESTLAKE VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91362-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-496-4202
Provider Business Practice Location Address Fax Number:
866-222-6636
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
TONY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST PRESIDENT CEO
Authorized Official Telephone Number:
805-208-4140

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 48231 , 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: 5624590 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHA482310 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".