1356754923 NPI number — ALAIN GABBAY D.D.S., INC.

Table of content: EBONY NICOLE MOORE LVN (NPI 1205336146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356754923 NPI number — ALAIN GABBAY D.D.S., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAIN GABBAY D.D.S., 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:
1356754923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 VAN NUYS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91401-1436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-988-5722
Provider Business Mailing Address Fax Number:
818-988-6252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 VAN NUYS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91401-1436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-988-5722
Provider Business Practice Location Address Fax Number:
818-988-6252
Provider Enumeration Date:
06/11/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GABBAY
Authorized Official First Name:
MYRA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
818-988-5722

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  30264 , 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)