1326476847 NPI number — COMPLETE LYMPHEDEMA CARE, INC.

Table of content: (NPI 1558530071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326476847 NPI number — COMPLETE LYMPHEDEMA CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE LYMPHEDEMA CARE, 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:
1326476847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11750 DUBLIN BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94568-2821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-550-3532
Provider Business Mailing Address Fax Number:
925-831-0315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11750 DUBLIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94568-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-550-3532
Provider Business Practice Location Address Fax Number:
925-831-0315
Provider Enumeration Date:
10/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RANKIN-MARTINEZ
Authorized Official First Name:
ALLYN
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
925-550-3532

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  OT 6553 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0400X , with the licence number: OT 6553 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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