1659494714 NPI number — DR. NANCY JOSEPHINE MARCUCELLA D.C., L.A.C

Table of content: DR. NANCY JOSEPHINE MARCUCELLA D.C., L.A.C (NPI 1659494714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659494714 NPI number — DR. NANCY JOSEPHINE MARCUCELLA D.C., L.A.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCUCELLA
Provider First Name:
NANCY
Provider Middle Name:
JOSEPHINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C., L.A.C
Provider Gender Code:
F

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:
1659494714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 S TOPANGA CANYON BLVD
Provider Second Line Business Mailing Address:
STE 210
Provider Business Mailing Address City Name:
TOPANGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90290-3159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-455-2225
Provider Business Mailing Address Fax Number:
310-455-0797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 S TOPANGA CANYON BLVD
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
TOPANGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90290-3159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-455-2225
Provider Business Practice Location Address Fax Number:
310-455-0797
Provider Enumeration Date:
04/06/2007

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: 111N00000X , with the licence number:  DC15790 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: AC4908 , 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)

  • Identifier: AC4908 . This is a "ACUPUNCTURE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954279766 . This is a "TAX I.D." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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