1285724948 NPI number — ALYSSA M. DALTON

Table of content: ALYSSA M. DALTON (NPI 1285724948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285724948 NPI number — ALYSSA M. DALTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALTON
Provider First Name:
ALYSSA
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DALTON
Provider Other First Name:
ALYSSA
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285724948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
99205-4805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-432-2088
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W 8TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99205-4805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-474-3131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2006

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: 207P00000X , with the licence number:  01060940A , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: P2222 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8DE452 . This is a "BCBS-TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 297619301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 297619302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8492449 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".