1508068370 NPI number — SAMILINE B CRUZ PHARMACY TECHNICIAN

Table of content: SAMILINE B CRUZ PHARMACY TECHNICIAN (NPI 1508068370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508068370 NPI number — SAMILINE B CRUZ PHARMACY TECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
SAMILINE
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACY TECHNICIAN
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:
1508068370
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:
157 BRET HARTE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94589-1925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-454-1451
Provider Business Mailing Address Fax Number:
415-454-2865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 TUNSTEAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANSELMO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94960-2616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-454-1451
Provider Business Practice Location Address Fax Number:
415-454-2865
Provider Enumeration Date:
06/04/2007

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: 183700000X , with the licence number:  TCH 60861 , 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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