1356471742 NPI number — MS. ELIZABETH ANN NEWQUIST MFT

Table of content: MS. ELIZABETH ANN NEWQUIST MFT (NPI 1356471742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356471742 NPI number — MS. ELIZABETH ANN NEWQUIST MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWQUIST
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
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:
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:
1356471742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10155 COLIMA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITTIER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90603-2042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-692-0383
Provider Business Mailing Address Fax Number:
562-205-0085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12225 BEVERLY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITTIER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90601-2966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-692-0383
Provider Business Practice Location Address Fax Number:
562-205-0085
Provider Enumeration Date:
03/06/2007

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:  MFC 40153 , 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)





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