1659576551 NPI number — CHRISTOPHER ACONE DDS

Table of content: CLARISSE YVETTE RAY-RUCKER MS (NPI 1093540320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659576551 NPI number — CHRISTOPHER ACONE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACONE
Provider First Name:
CHRISTOPHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1659576551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3220 SEPULVEDA BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90505-2744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-263-4919
Provider Business Mailing Address Fax Number:
424-263-4921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3220 SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-2744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-263-4919
Provider Business Practice Location Address Fax Number:
424-263-4921
Provider Enumeration Date:
06/19/2007

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: 1223P0300X , with the licence number:  50879 , 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: 002128977 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 841649733 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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