1407847098 NPI number — MRS. TRISHA KAE VORACHEK RD

Table of content: MRS. TRISHA KAE VORACHEK RD (NPI 1407847098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407847098 NPI number — MRS. TRISHA KAE VORACHEK RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VORACHEK
Provider First Name:
TRISHA
Provider Middle Name:
KAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD
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:
1407847098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 LEEWARD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VACAVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95687-5222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-448-1821
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 BODIN CIR
Provider Second Line Business Practice Location Address:
60 MDTS/SGQD
Provider Business Practice Location Address City Name:
TRAVIS AFB
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94535-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-423-7405
Provider Business Practice Location Address Fax Number:
707-423-3627
Provider Enumeration Date:
11/02/2005

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14694 . This is a "HFI FROM ACSM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 812181 . This is a "CDR FOR RD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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