1811233661 NPI number — SUNSET PSYCHIATRIC MEDICAL CENTER

Table of content: MRS. MARTHA JANE VANDYCK DPH (NPI 1467720235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811233661 NPI number — SUNSET PSYCHIATRIC MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSET PSYCHIATRIC MEDICAL CENTER
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:
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:
1811233661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
933 S SUNSET AVE
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
WEST COVINA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91790-3410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-813-1222
Provider Business Mailing Address Fax Number:
626-813-1221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
933 S SUNSET AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
WEST COVINA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91790-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-813-1222
Provider Business Practice Location Address Fax Number:
626-813-1221
Provider Enumeration Date:
12/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WONG
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
626-813-1222

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  PSY21007 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 313M00000X , with the licence number: PSY21007 , 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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