1932178456 NPI number — DR. MAYA M VAZIRANI M.D.

Table of content: DR. MAYA M VAZIRANI M.D. (NPI 1932178456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932178456 NPI number — DR. MAYA M VAZIRANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZIRANI
Provider First Name:
MAYA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1932178456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 W AVENUE J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93534-2703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-945-6717
Provider Business Mailing Address Fax Number:
661-945-6718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 W AVENUE J
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-945-6717
Provider Business Practice Location Address Fax Number:
661-945-6718
Provider Enumeration Date:
03/16/2006

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: 208000000X , with the licence number:  A33369 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080N0001X , with the licence number: A33369 , 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)

  • Identifier: N96036 . This is a "BLUE CROSS OF CA MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 953804947 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00A333690 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0101029195 . This is a "PHYSICIAN &SURGEON" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: A33369 . This is a "PHYSICIAN & SURGEON LICEN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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