1386833283 NPI number — MRS. SALINA MARIE DRENNAN CATC III

Table of content: CHARLES AMANZE (NPI 1386088623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386833283 NPI number — MRS. SALINA MARIE DRENNAN CATC III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRENNAN
Provider First Name:
SALINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CATC III
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VILLA
Provider Other First Name:
SALINA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RAS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386833283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
768 PLEASANT VALLEY RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
DIAMOND SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95619-9260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-621-6207
Provider Business Mailing Address Fax Number:
530-295-2596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
768 PLEASANT VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
DIAMOND SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95619-9260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-621-6207
Provider Business Practice Location Address Fax Number:
530-295-2596
Provider Enumeration Date:
10/17/2007

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: 101YA0400X , with the licence number:  168169 III , 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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