1386613941 NPI number — DIXIE STILES NP

Table of content: DIXIE STILES NP (NPI 1386613941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386613941 NPI number — DIXIE STILES NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STILES
Provider First Name:
DIXIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1386613941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 W LA VETA AVE
Provider Second Line Business Mailing Address:
SUITE 570
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-835-7700
Provider Business Mailing Address Fax Number:
714-835-8145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 W LA VETA AVE
Provider Second Line Business Practice Location Address:
SUITE 570
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-835-7700
Provider Business Practice Location Address Fax Number:
714-835-8145
Provider Enumeration Date:
03/16/2006

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: 363L00000X , with the licence number:  508290 , 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: CG5665 . This is a "RAIL ROAD MEDICARE - GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W1514 . This is a "MEDICARE PTAN - TYPE 2" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P00140070 . This is a "RAIL ROAD MEDICARE - PROVIDER PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912919804 . This is a "NPI - TYPE 2" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com