1285863696 NPI number — TEMECULA CA ENDOSCOPY ASC LP

Table of content: (NPI 1285863696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285863696 NPI number — TEMECULA CA ENDOSCOPY ASC LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEMECULA CA ENDOSCOPY ASC LP
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:
TEMECULA VALLEY ENDOSCOPY CENTER
Provider Other Organization Name Type Code:
3
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:
1285863696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25150 HANCOCK AVE
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92562-5987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-698-8805
Provider Business Mailing Address Fax Number:
951-698-8898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25150 HANCOCK AVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92562-5987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-698-8805
Provider Business Practice Location Address Fax Number:
951-698-8898
Provider Enumeration Date:
07/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BUSINESS OPERATIONS
Authorized Official Telephone Number:
951-698-8805

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AS308X . This is a "CRNA - SANDBERG" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CH801Z . This is a "CRNA-PERRENOUD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BU941Y . This is a "CRNA - LUCAS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DB330Z . This is a "CRNA - FERGUSON" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AZ149X . This is a "CRNA - MCNAMARA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CY651Z . This is a "CRNA - LYNN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BB070W . This is a "CRNA BJERK" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CE284Y . This is a "CRNA - STALLMER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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