1780607648 NPI number — ANDRIA GIANNA MARI LANGENBERG MD

Table of content: ANDRIA GIANNA MARI LANGENBERG MD (NPI 1780607648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780607648 NPI number — ANDRIA GIANNA MARI LANGENBERG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGENBERG
Provider First Name:
ANDRIA
Provider Middle Name:
GIANNA MARI
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:
1780607648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94120-7464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-206-3103
Provider Business Mailing Address Fax Number:
415-206-3872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 POTRERO AVENUE
Provider Second Line Business Practice Location Address:
BLDG 90 WARD 92 RM 224
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94110-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-206-8680
Provider Business Practice Location Address Fax Number:
415-206-4317
Provider Enumeration Date:
07/25/2006

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: 207N00000X , with the licence number:  G52236 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X , with the licence number: G52236 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 00G522360 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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