1891966198 NPI number — DR. YADI F SWEENY PSYD

Table of content: DR. YADI F SWEENY PSYD (NPI 1891966198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891966198 NPI number — DR. YADI F SWEENY PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEENY
Provider First Name:
YADI
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
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:
1891966198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 E 2ND ST
Provider Second Line Business Mailing Address:
HPC 2ND FLOOR SUITE 2255 OR 2215
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91766-1854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-469-8332
Provider Business Mailing Address Fax Number:
909-706-3780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
795 E 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91766-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-706-3779
Provider Business Practice Location Address Fax Number:
909-620-1048
Provider Enumeration Date:
03/14/2008

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:  PSY18095 , 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: PSY 18095 . This is a "CA CLINICAL PSY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AV772U . This is a "MEDICARE SO. PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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