1376775452 NPI number — MS. RUTH BARBARA ROESCHLAU R.N.,P.H.N

Table of content: DR. JOSHUA Z STEINER DO (NPI 1427046887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376775452 NPI number — MS. RUTH BARBARA ROESCHLAU R.N.,P.H.N

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROESCHLAU
Provider First Name:
RUTH
Provider Middle Name:
BARBARA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.N.,P.H.N
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:
1376775452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASSEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96016-0027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-335-5882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36977 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96013-4067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-335-3651
Provider Business Practice Location Address Fax Number:
530-335-5241
Provider Enumeration Date:
08/21/2009

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: 163W00000X , with the licence number:  96824 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SC1501X , with the licence number: 10151 , 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: PHN10151 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RN96824 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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