1366765752 NPI number — POWER THERAPEUTICS, LLC

Table of content: (NPI 1366765752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366765752 NPI number — POWER THERAPEUTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POWER THERAPEUTICS, LLC
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:
1366765752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 221021
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CLARITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91322-1021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-312-3065
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25000 AVENUE STANFORD STE 260
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-4793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-588-1172
Provider Business Practice Location Address Fax Number:
888-569-0789
Provider Enumeration Date:
03/12/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BADAWI
Authorized Official First Name:
HIETHEM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
866-588-1172

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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)