1700098480 NPI number — RICHARD A SPITZER MD A MEDICAL CORPORATION

Table of content: (NPI 1700098480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700098480 NPI number — RICHARD A SPITZER MD A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD A SPITZER MD A MEDICAL CORPORATION
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:
6
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:
1700098480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 ALESSANDRO PLACE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91105-4010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-449-1814
Provider Business Mailing Address Fax Number:
626-449-0007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 ALESSANDRO PLACE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-449-1814
Provider Business Practice Location Address Fax Number:
626-449-0007
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SPITZER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
626-449-1814

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00G190180 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DN7881 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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