1396942983 NPI number — DR. DAVID ALLAN CONNETT D.O.

Table of content: DR. DAVID ALLAN CONNETT D.O. (NPI 1396942983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396942983 NPI number — DR. DAVID ALLAN CONNETT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONNETT
Provider First Name:
DAVID
Provider Middle Name:
ALLAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1396942983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 E 2ND ST
Provider Second Line Business Mailing Address:
HPC 2ND FLOOR SUITE 2255 OR 2215
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91766-1854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-469-8332
Provider Business Mailing Address Fax Number:
909-706-3780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8686 HAVEN AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-9109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-706-3950
Provider Business Practice Location Address Fax Number:
909-257-2300
Provider Enumeration Date:
06/28/2007

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: 207Q00000X , with the licence number:  20A9771 , 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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