1831631332 NPI number — MEDICAL SUPPORT LOS ANGELES A MEDICAL CORPORATION

Table of content: JEFFREY J. MONIZ RRT (NPI 1770634040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831631332 NPI number — MEDICAL SUPPORT LOS ANGELES A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL SUPPORT LOS ANGELES A MEDICAL CORPORATION
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:
6
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:
1831631332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1294 E COLORADO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91106-1901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-407-2152
Provider Business Mailing Address Fax Number:
626-239-3666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12900 GARDEN GROVE BLVD
Provider Second Line Business Practice Location Address:
BUILDING B, SUITE #235
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92843-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-590-8798
Provider Business Practice Location Address Fax Number:
714-590-8527
Provider Enumeration Date:
11/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SICIARZ-LAMBERT
Authorized Official First Name:
SAHNIAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
626-407-2152

Provider Taxonomy Codes

  • Taxonomy code: 202C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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