1427253772 NPI number — MR. LEONARD GREEN VAN NOSTRAND II

Table of content: MR. LEONARD GREEN VAN NOSTRAND II (NPI 1427253772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427253772 NPI number — MR. LEONARD GREEN VAN NOSTRAND II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN NOSTRAND
Provider First Name:
LEONARD
Provider Middle Name:
GREEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN NOSTRAND
Provider Other First Name:
LEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., MFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1427253772
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:
7420 SAN BERGAMO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93117-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-961-4401
Provider Business Mailing Address Fax Number:
805-961-4401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E ARRELLAGA ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93103-2274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-886-1963
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2007

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: 106H00000X , with the licence number:  MFC37919 , 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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