1750484374 NPI number — AUGUSTA J SAULYS MD

Table of content: AUGUSTA J SAULYS MD (NPI 1750484374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750484374 NPI number — AUGUSTA J SAULYS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAULYS
Provider First Name:
AUGUSTA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1750484374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 CLIFF WALK DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-648-1672
Provider Business Mailing Address Fax Number:
510-450-5836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 52ND ST
Provider Second Line Business Practice Location Address:
EMERG DEPT CHILDRENS HOSP & RESEARCH CENTER AT OAKLAND
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-428-3259
Provider Business Practice Location Address Fax Number:
510-450-5836
Provider Enumeration Date:
09/07/2006

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: 2080P0204X , with the licence number:  C41925 , 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: 5974633 . This is a "MEDICAL" identifier . This identifiers is of the category "OTHER".




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