1477699163 NPI number — MRS. GINA MARIE BERUMEN 13 YRS OF EDUCATION

Table of content: MRS. GINA MARIE BERUMEN 13 YRS OF EDUCATION (NPI 1477699163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477699163 NPI number — MRS. GINA MARIE BERUMEN 13 YRS OF EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERUMEN
Provider First Name:
GINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
13 YRS OF EDUCATION
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:
1477699163
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:
2001 THE ALAMEDA
Provider Second Line Business Mailing Address:
ALLIANCE FOR COMMUNITY CARE
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95126-1136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-261-7777
Provider Business Mailing Address Fax Number:
408-254-9960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 THE ALAMEDA
Provider Second Line Business Practice Location Address:
ALLIANCE FOR COMM CARE SERVICE TEAM ADULT OUTPATIENT
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95126-1136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-261-7777
Provider Business Practice Location Address Fax Number:
408-554-9960
Provider Enumeration Date:
01/29/2007

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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