1356525182 NPI number — NORTH ORANGE COUNTY PEDIATRICS CHILES DAN W ET AL GEN PTRS

Table of content: KATRINA BRIANNA MARTIN LPN (NPI 1922537117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356525182 NPI number — NORTH ORANGE COUNTY PEDIATRICS CHILES DAN W ET AL GEN PTRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH ORANGE COUNTY PEDIATRICS CHILES DAN W ET AL GEN PTRS
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:
1356525182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 LAGUNA RD
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92835-2523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-879-2980
Provider Business Mailing Address Fax Number:
714-879-5134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 LAGUNA RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92835-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-879-2980
Provider Business Practice Location Address Fax Number:
714-879-5134
Provider Enumeration Date:
12/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BACHA
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
714-879-2980

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  A23480 , 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)

  • Identifier: GR0024380 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A26098 . This is a "MEDICAL LIC NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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