1871516203 NPI number — BIONESS INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871516203 NPI number — BIONESS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIONESS INC.
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:
1871516203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25103 RYE CANYON LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91355-5004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-362-4850
Provider Business Mailing Address Fax Number:
661-362-6661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25103 RYE CANYON LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-362-4850
Provider Business Practice Location Address Fax Number:
661-362-6661
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIPPER
Authorized Official First Name:
SHELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER, BILLING & COLLECTIONS
Authorized Official Telephone Number:
800-211-9136

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  43291 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 48442 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: HMDR#48442 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: HMDR#48442 , 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: 015862500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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