1659769719 NPI number — DENISE COLLEEN AGUILAR DEL CANO COTA

Table of content: DENISE COLLEEN AGUILAR DEL CANO COTA (NPI 1659769719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659769719 NPI number — DENISE COLLEEN AGUILAR DEL CANO COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEL CANO
Provider First Name:
DENISE COLLEEN
Provider Middle Name:
AGUILAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
COTA
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:
1659769719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 VIA ESPERANZA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO SANTA MARGARITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92688-1941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-584-4513
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 OLD TUSTIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-7810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-835-4900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2014

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: 224Z00000X , with the licence number:  2006 , 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)





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