1376930057 NPI number — MISS LIANA GROEL M.S., A.T.C.

Table of content: MISS LIANA GROEL M.S., A.T.C. (NPI 1376930057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376930057 NPI number — MISS LIANA GROEL M.S., A.T.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROEL
Provider First Name:
LIANA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.S., A.T.C.
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:
1376930057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 RANCHO DEL ORO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92057-8316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-901-8000
Provider Business Mailing Address Fax Number:
760-721-7065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 RANCHO DEL ORO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92057-8316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-901-8000
Provider Business Practice Location Address Fax Number:
760-721-7065
Provider Enumeration Date:
04/21/2015

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: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2000002264 . This is a "NATA BOC" identifier . This identifiers is of the category "OTHER".




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