1891853149 NPI number — R. CICCARELLI, DDS., R. JOSEPH, DDS., M. EL FARRA, DDS., D. SAINI, DDS

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 1891853149 NPI number — R. CICCARELLI, DDS., R. JOSEPH, DDS., M. EL FARRA, DDS., D. SAINI, DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R. CICCARELLI, DDS., R. JOSEPH, DDS., M. EL FARRA, DDS., D. SAINI, DDS
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:
M. HOCHHALTER, DDS., B. MOREHEAD, DDS., M BLEDSOE, DDS, INC DBA VALLEY
Provider Other Organization Name Type Code:
4
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:
1891853149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1507 W. YOSEMITE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANTECA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-823-9341
Provider Business Mailing Address Fax Number:
209-823-5091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1507 W. YOSEMITE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANTECA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-823-9341
Provider Business Practice Location Address Fax Number:
209-823-5091
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOREHEAD
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CORPORATE TREASURER
Authorized Official Telephone Number:
209-823-9341

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  28362 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 53028 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 50181 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 54048 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 35699 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 42922 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 51062 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 26998 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 34614 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 38406 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 59209 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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