1740019108 NPI number — CARECONNECTMD DISTRICT OF COLUMBIA PC

Table of content: (NPI 1740019108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740019108 NPI number — CARECONNECTMD DISTRICT OF COLUMBIA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARECONNECTMD DISTRICT OF COLUMBIA PC
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:
1740019108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3090 BRISTOL ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COSTA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92626-3061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-789-9585
Provider Business Mailing Address Fax Number:
562-803-4500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 F ST NW FL 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20001-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-789-9585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2024

Additional Information

Authorized Official

Authorized Official Last Name:
COLLADO
Authorized Official First Name:
ORLANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
714-514-6118

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com