1700801867 NPI number — DR. RICHARD HAROLD HAAS M.D.

Table of content: MR. RANDALL E REESE MD (NPI 1285718676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700801867 NPI number — DR. RICHARD HAROLD HAAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAAS
Provider First Name:
RICHARD
Provider Middle Name:
HAROLD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1700801867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3860 CALLE FORTUNADA
Provider Second Line Business Mailing Address:
STE #210
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-4802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-309-6303
Provider Business Mailing Address Fax Number:
858-309-6301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8010 FROST ST
Provider Second Line Business Practice Location Address:
STE 510
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-966-5819
Provider Business Practice Location Address Fax Number:
858-966-4930
Provider Enumeration Date:
07/12/2006

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: 2084N0402X , with the licence number:  A38555 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: A38555 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00A385550 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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