1851431977 NPI number — MR. DAVID LINDLEY HELLWIG PHD

Table of content: MR. DAVID LINDLEY HELLWIG PHD (NPI 1851431977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851431977 NPI number — MR. DAVID LINDLEY HELLWIG PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HELLWIG
Provider First Name:
DAVID
Provider Middle Name:
LINDLEY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1851431977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1357 W SHAW AVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93711-3618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-227-4800
Provider Business Mailing Address Fax Number:
559-222-3939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1357 W SHAW AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93711-3618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-227-4800
Provider Business Practice Location Address Fax Number:
559-222-3939
Provider Enumeration Date:
02/07/2007

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: 103TC0700X , with the licence number:  PSY14566 , 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: CI920A . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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