1457541633 NPI number — ACCESS MEDICAL CENTERS, A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1457541633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457541633 NPI number — ACCESS MEDICAL CENTERS, A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS MEDICAL CENTERS, A PROFESSIONAL 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:
ACCESS MEDICAL CENTERS, A PROFESSIONAL MEDICAL CORPORATION
Provider Other Organization Name Type Code:
3
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:
1457541633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
477 N. EL CAMINO REAL
Provider Second Line Business Mailing Address:
SUITE A100
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-729-2351
Provider Business Mailing Address Fax Number:
760-729-9675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2626 EL CAMINO REAL STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008-1253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-729-2351
Provider Business Practice Location Address Fax Number:
760-729-9675
Provider Enumeration Date:
07/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GORIN
Authorized Official First Name:
ROBERTA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
760-729-2351

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  G80982 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X , with the licence number: G80982 , 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)





Copyright © 2007-2024 www.npivalidator.com