1821378068 NPI number — MISS THERESA BARCARSE LANE STUDENT

Table of content: MISS THERESA BARCARSE LANE STUDENT (NPI 1821378068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821378068 NPI number — MISS THERESA BARCARSE LANE STUDENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANE
Provider First Name:
THERESA
Provider Middle Name:
BARCARSE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
STUDENT
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:
1821378068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 CORPORATE DR APT 527
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LADERA RANCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92694-1114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-228-1463
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 3RD AVENUE, SUITE C
Provider Second Line Business Practice Location Address:
COMMUNITY RESEARCH FOUNDATION
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-427-4661
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2011

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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