1508079690 NPI number — HEART SAVERS LLC

Table of content: (NPI 1508079690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508079690 NPI number — HEART SAVERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART SAVERS LLC
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:
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:
1508079690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4050 BARRANCA PKWY
Provider Second Line Business Mailing Address:
SUITE # 170
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92604-7706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-786-6600
Provider Business Mailing Address Fax Number:
949-786-5282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4050 BARRANCA PKWY
Provider Second Line Business Practice Location Address:
SUITE # 170
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92604-7706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-786-6600
Provider Business Practice Location Address Fax Number:
949-786-5282
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FALLAH
Authorized Official First Name:
MEHRNAZ
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
949-786-6600

Provider Taxonomy Codes

  • Taxonomy code: 2471C3401X , with the licence number:  RHT66746,RHF63243 , 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: TG453 . This is a "GROUP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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