1518735414 NPI number — MISS AHTZIRI CIBRIAN BACHELORS

Table of content: MISS AHTZIRI CIBRIAN BACHELORS (NPI 1518735414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518735414 NPI number — MISS AHTZIRI CIBRIAN BACHELORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIBRIAN
Provider First Name:
AHTZIRI
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BACHELORS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CIBRIAN
Provider Other First Name:
AHTZIRI
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BACHELORS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518735414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19817 SMITH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERRIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92570-9305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-273-1226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6876 MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92506-2860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-992-3039
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2023

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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