1730124215 NPI number — DR. HOWARD ANDREW COREN M.D.

Table of content: DR. HOWARD ANDREW COREN M.D. (NPI 1730124215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730124215 NPI number — DR. HOWARD ANDREW COREN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COREN
Provider First Name:
HOWARD
Provider Middle Name:
ANDREW
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:
1730124215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 OAK KNOLL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UKIAH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-362-0403
Provider Business Mailing Address Fax Number:
707-462-7846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COUNTY OF MENDOCINO DEPARTMENT OF PUBLIC HEALTH
Provider Second Line Business Practice Location Address:
1120 SOUTH DORA ST
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-472-2600
Provider Business Practice Location Address Fax Number:
707-472-2773
Provider Enumeration Date:
06/18/2006

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: 207Q00000X , with the licence number:  G28969 , 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)

  • Identifier: 00G239690 . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G289690 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5542977 . This is a "CCN/FIRST HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5230656 . This is a "AETNA PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 680121024 . This is a "BLUE CROSS OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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