1780880195 NPI number — RAY ALEXIUS PANINSORO SATINA P.T.

Table of content: RAY ALEXIUS PANINSORO SATINA P.T. (NPI 1780880195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780880195 NPI number — RAY ALEXIUS PANINSORO SATINA P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SATINA
Provider First Name:
RAY ALEXIUS
Provider Middle Name:
PANINSORO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1780880195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
388 W TULIP TREE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92865-1091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-906-8399
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 ODYSSEY
Provider Second Line Business Practice Location Address:
SUITE # 165
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-3186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-727-2192
Provider Business Practice Location Address Fax Number:
949-727-2193
Provider Enumeration Date:
06/22/2007

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: 225100000X , with the licence number:  29145 , 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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