1891193785 NPI number — MARLENE MIRIGIAN SVENSSON AU.D

Table of content: MARLENE MIRIGIAN SVENSSON AU.D (NPI 1891193785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891193785 NPI number — MARLENE MIRIGIAN SVENSSON AU.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SVENSSON
Provider First Name:
MARLENE
Provider Middle Name:
MIRIGIAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D
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:
1891193785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 SHUMAN BLVD STE 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-8123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-303-5380
Provider Business Mailing Address Fax Number:
978-313-6824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 DOUGLAS BLVD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95678-2762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-773-9148
Provider Business Practice Location Address Fax Number:
916-773-9150
Provider Enumeration Date:
12/09/2014

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: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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