1760690200 NPI number — ADA DEL RIVERO-YAMUY MEDICAL CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760690200 NPI number — ADA DEL RIVERO-YAMUY MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADA DEL RIVERO-YAMUY MEDICAL CORP
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:
1760690200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3831 HUGHES AVE.
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CULVER CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-204-0104
Provider Business Mailing Address Fax Number:
310-204-0171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3831 HUGHES AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CULVER CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90232-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-204-0104
Provider Business Practice Location Address Fax Number:
310-204-0171
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEL RIVERO YAMUY
Authorized Official First Name:
ADA
Authorized Official Middle Name:
ELENA
Authorized Official Title or Position:
GENERAL PHYSICIAN
Authorized Official Telephone Number:
310-204-0104

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  A83694 , 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)





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