1801128368 NPI number — TAMARA T. KURMANALIEVA, PC

Table of content: (NPI 1801128368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801128368 NPI number — TAMARA T. KURMANALIEVA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMARA T. KURMANALIEVA, 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:
TUMESH FOR OPTIMAL HEALTH
Provider Other Organization Name Type Code:
3
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:
1801128368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4920 BARRANCA PKWY
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92604-4672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-387-8422
Provider Business Mailing Address Fax Number:
949-387-8423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 BARRANCA PKWY
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92604-4672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-387-8422
Provider Business Practice Location Address Fax Number:
949-387-8423
Provider Enumeration Date:
02/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KURMANALIEVA
Authorized Official First Name:
TAMARA
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-387-8422

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A98504 , 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: 0UW892, 0844892 . This is a "BLUE CROSS/BLUE CROSS SENIOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 144535 . This is a "HEALTH NET/HEALTH NET SENIOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 426431 . This is a "AETNA/AETNA SENIOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7G0847/8U0694/L80885 . This is a "BLUE SHIELD 65 PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0219630488 . This is a "SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 091808 . This is a "SCAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00A985040 . This is a "ONECARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0149050651 . This is a "PACIFICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7261810002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00A985040 . This is a "CALOPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00A985040 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00985040 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0022776230002 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".




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