1295860195 NPI number — VIRGINIA ANN GARDNER MFT

Table of content: MR. RYAN MATTHEW ANLIKER I B.S. (NPI 1225588858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295860195 NPI number — VIRGINIA ANN GARDNER MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDNER
Provider First Name:
VIRGINIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARDNER
Provider Other First Name:
GINI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1295860195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 WOODLEAF CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94945-1325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-209-9454
Provider Business Mailing Address Fax Number:
415-892-0318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 SIR FRANCIS DRAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
KENTFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94904-1588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-339-8662
Provider Business Practice Location Address Fax Number:
415-892-0318
Provider Enumeration Date:
02/22/2007

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: 106H00000X , with the licence number:  MFC36879 , 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)