1619122678 NPI number — DR. RONALD WORTH SWAN PH.D.

Table of content: DR. RONALD WORTH SWAN PH.D. (NPI 1619122678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619122678 NPI number — DR. RONALD WORTH SWAN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAN
Provider First Name:
RONALD
Provider Middle Name:
WORTH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

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:
1619122678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 WESTGATE DR
Provider Second Line Business Mailing Address:
#236
Provider Business Mailing Address City Name:
WATSONVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95076-2461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-728-3707
Provider Business Mailing Address Fax Number:
831-728-3707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 WESTGATE DR
Provider Second Line Business Practice Location Address:
#236
Provider Business Practice Location Address City Name:
WATSONVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95076-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-728-3707
Provider Business Practice Location Address Fax Number:
831-728-3707
Provider Enumeration Date:
11/18/2008

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: 103T00000X , with the licence number:  PSY 6916 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC1900X , with the licence number: PSY 6916 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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