1497739908 NPI number — CECILE VASQUEZ COAKER PT

Table of content: DAISY ALEXA POLANCO (NPI 1366136871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497739908 NPI number — CECILE VASQUEZ COAKER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COAKER
Provider First Name:
CECILE
Provider Middle Name:
VASQUEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VASQUEZ
Provider Other First Name:
CECILE
Provider Other Middle Name:
SAMSON
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497739908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 GARDEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-5313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-375-1885
Provider Business Mailing Address Fax Number:
831-375-7436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2230 GLADSTONE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94565-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-427-5155
Provider Business Practice Location Address Fax Number:
925-427-9552
Provider Enumeration Date:
11/30/2005

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: 225100000X , with the licence number:  PT28243 , 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)

  • Identifier: 0PT282431 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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