1356761431 NPI number — NANU MEDICAL CORP

Table of content: (NPI 1356761431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356761431 NPI number — NANU MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANU MEDICAL CORP
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:
PACIFIC NEUROPSYCHIATRY AND SLEEP
Provider Other Organization Name Type Code:
3
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:
1356761431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 PASO ROBLES
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92602-1091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-420-2478
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 ODYSSEY STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-7700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-207-3797
Provider Business Practice Location Address Fax Number:
949-207-3799
Provider Enumeration Date:
04/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CHAND
Authorized Official First Name:
RAVINDRA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT AND OWNER
Authorized Official Telephone Number:
312-420-2478

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  C52842 , 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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