1659824837 NPI number — DAP HEALTH

Table of content: (NPI 1659824837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659824837 NPI number — DAP HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAP HEALTH
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:
DBA STONEWALL PHARMACY
Provider Other Organization Name Type Code:
3
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:
1659824837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1695 N SUNRISE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-323-2118
Provider Business Mailing Address Fax Number:
858-634-6931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68555 RAMON ROAD
Provider Second Line Business Practice Location Address:
SUITE D105
Provider Business Practice Location Address City Name:
CATHEDRAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-767-3047
Provider Business Practice Location Address Fax Number:
858-635-6931
Provider Enumeration Date:
07/25/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STITH
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
760-323-2118

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY54625 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2166135 . This is a "PK" identifier . This identifiers is of the category "OTHER".