1649306911 NPI number — RANCHO CAPISTRANO MEDICAL CLINIC

Table of content: ARIEL KAY TRUDELL LPC (NPI 1356936678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649306911 NPI number — RANCHO CAPISTRANO MEDICAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANCHO CAPISTRANO MEDICAL CLINIC
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:
6
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:
1649306911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34052 LA PLZ STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANA POINT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92629-2571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-240-2555
Provider Business Mailing Address Fax Number:
949-240-2121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34052 LA PLZ STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANA POINT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92629-2571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-240-2555
Provider Business Practice Location Address Fax Number:
949-240-2121
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GAIKWAD
Authorized Official First Name:
SHILPA
Authorized Official Middle Name:
JAGDISH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-240-2555

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ65759Z . This is a "BLUE SHIELD PROVIDER NO." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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