1699061515 NPI number — LUCINDA ANN RATHBUN MFTI #63054

Table of content: LUCINDA ANN RATHBUN MFTI #63054 (NPI 1699061515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699061515 NPI number — LUCINDA ANN RATHBUN MFTI #63054

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RATHBUN
Provider First Name:
LUCINDA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFTI #63054
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVENPORT
Provider Other First Name:
LUCINDA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699061515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
438 COLUSA AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
YUBA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95991-4148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-755-0735
Provider Business Mailing Address Fax Number:
530-755-0737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
438 COLUSA AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
YUBA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95991-4148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-755-0735
Provider Business Practice Location Address Fax Number:
530-755-0737
Provider Enumeration Date:
06/20/2011

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: 106H00000X , with the licence number:  IMF 63054 , 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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