1659414142 NPI number — ORTHOODNTICS ONLY

Table of content: ANNE TRACY WINN LMT (NPI 1912148610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659414142 NPI number — ORTHOODNTICS ONLY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOODNTICS ONLY
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:
1659414142
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:
11633 HAWTHORNE BLVD
Provider Second Line Business Mailing Address:
SUITE #500
Provider Business Mailing Address City Name:
HAWTHORNE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90250-2321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-644-4412
Provider Business Mailing Address Fax Number:
310-644-7355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11633 HAWTHORNE BLVD
Provider Second Line Business Practice Location Address:
SUITE #500
Provider Business Practice Location Address City Name:
HAWTHORNE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90250-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-644-4412
Provider Business Practice Location Address Fax Number:
310-644-7355
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENBERG
Authorized Official First Name:
FAREL
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
310-644-4412

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  17997 , 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: 189379 . This is a "CIGNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 259102 . This is a "DELTACARE PMI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B102 . This is a "GOLDENWEST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 98118 . This is a "AETNA DMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 105969 . This is a "CIGNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G90737-01 . This is a "DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 102231 . This is a "DHS INSURANCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7072 . This is a "PACIFIC UNION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 549733 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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