1407874134 NPI number — HIGH DESERT GASTROENTEROLOGY INC

Table of content: DEBORAH LYN RANDAISI R.P.A (NPI 1073545166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407874134 NPI number — HIGH DESERT GASTROENTEROLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGH DESERT GASTROENTEROLOGY INC
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:
1407874134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5988
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93539-5988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-948-0803
Provider Business Mailing Address Fax Number:
661-948-5004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1753 W AVENUE J STE B
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-9823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-948-0803
Provider Business Practice Location Address Fax Number:
661-948-5004
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
RAMAN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
661-948-0803

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0070410 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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