1881685295 NPI number — MR. RODRIGO AVELLANA CHENG JR. NP

Table of content: MR. RODRIGO AVELLANA CHENG JR. NP (NPI 1881685295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881685295 NPI number — MR. RODRIGO AVELLANA CHENG JR. NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHENG
Provider First Name:
RODRIGO
Provider Middle Name:
AVELLANA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
NP
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:
1881685295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BLDG H-100, SANTA MARGARITA ROAD
Provider Second Line Business Mailing Address:
NAVAL HOSPITAL
Provider Business Mailing Address City Name:
CAMP PENDLETON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-725-1213
Provider Business Mailing Address Fax Number:
760-725-1303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLDG H-100, SANTA MARGARITA ROAD
Provider Second Line Business Practice Location Address:
NAVAL HOSPITAL
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-1213
Provider Business Practice Location Address Fax Number:
760-725-1303
Provider Enumeration Date:
11/03/2005

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: 363LF0000X , with the licence number:  RN481187 NP 11428 , 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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