1306021225 NPI number — ALLERGY ASTHMA AND IMMUNOLOGY CARE SPECIALIST INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306021225 NPI number — ALLERGY ASTHMA AND IMMUNOLOGY CARE SPECIALIST INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY ASTHMA AND IMMUNOLOGY CARE SPECIALIST 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:
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:
1306021225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23838 VALENCIA BLVD
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91355-5319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-559-8276
Provider Business Mailing Address Fax Number:
310-559-8284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23838 VALENCIA BLVD
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-5319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-559-8276
Provider Business Practice Location Address Fax Number:
310-559-8284
Provider Enumeration Date:
01/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LORETO
Authorized Official First Name:
MARILOU
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
310-559-8276

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  A52285 , 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