1285905489 NPI number — MRS. ANDREA VIRINDA TONASUT MILLET NP

Table of content: MRS. ANDREA VIRINDA TONASUT MILLET NP (NPI 1285905489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285905489 NPI number — MRS. ANDREA VIRINDA TONASUT MILLET NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TONASUT MILLET
Provider First Name:
ANDREA
Provider Middle Name:
VIRINDA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLET
Provider Other First Name:
ANDREA
Provider Other Middle Name:
TONASUT
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285905489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7483 SEQUOIA LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92346-7731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-649-4660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 N HERITAGE DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-5543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-371-9160
Provider Business Practice Location Address Fax Number:
661-729-6864
Provider Enumeration Date:
01/19/2012

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: 363L00000X , with the licence number:  13799 , 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)





Copyright © 2007-2024 www.npivalidator.com