1578977161 NPI number — MS. ALICIA BOGGIO STITELER L.C.S.W.

Table of content: MS. ALICIA BOGGIO STITELER L.C.S.W. (NPI 1578977161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578977161 NPI number — MS. ALICIA BOGGIO STITELER L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STITELER
Provider First Name:
ALICIA
Provider Middle Name:
BOGGIO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOGGIO
Provider Other First Name:
ALICIA
Provider Other Middle Name:
SUE
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:
1578977161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 OCEANGATE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90802-4317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-620-7769
Provider Business Mailing Address Fax Number:
877-778-6944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
887 E. SECOND ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91766-2009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-620-7769
Provider Business Practice Location Address Fax Number:
877-778-6944
Provider Enumeration Date:
06/11/2014

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: 1041C0700X , with the licence number:  25452 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: LCS25452 , 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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