1689627317 NPI number — LA JOLLA RADIOLOGY MEDICAL GROUP - DIAGNOSIS, INC.

Table of content: MRS. JENNIFER KRAMPERT APRN (NPI 1194461400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689627317 NPI number — LA JOLLA RADIOLOGY MEDICAL GROUP - DIAGNOSIS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA JOLLA RADIOLOGY MEDICAL GROUP - DIAGNOSIS, INC.
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:
1689627317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2570
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91319-2570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-386-8024
Provider Business Mailing Address Fax Number:
805-375-8900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10150 SORRENTO VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-454-4235
Provider Business Practice Location Address Fax Number:
858-454-4644
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCREIGHT
Authorized Official First Name:
PETER
Authorized Official Middle Name:
H.B.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
858-454-4235

Provider Taxonomy Codes

  • Taxonomy code: 207U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0006796 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ00191Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ00872Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ71703Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ23443Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ777070Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ00192Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR0006799 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ00873Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ71703Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ73863Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ73863Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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