1396710133 NPI number — ANTONIO E CABINIAN A MEDICAL CORPORATION

Table of content: MISS AMY LYNN MENZIES MS, ATC, LAT (NPI 1295005593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396710133 NPI number — ANTONIO E CABINIAN A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTONIO E CABINIAN A MEDICAL CORPORATION
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:
1396710133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 867
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91908-0867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-267-0200
Provider Business Mailing Address Fax Number:
619-267-9870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 MEDICAL CENTER CT
Provider Second Line Business Practice Location Address:
SHARP CHULA VISTA MEDICAL CENTER
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-6617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-267-0200
Provider Business Practice Location Address Fax Number:
619-267-9870
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CABINIAN
Authorized Official First Name:
ANTONIO
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
619-267-0200

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  A45959 , 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: 00A459590 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A45959 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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