1932398450 NPI number — SHYAM ULLAL,PT A PROF.CORP

Table of content: (NPI 1932398450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932398450 NPI number — SHYAM ULLAL,PT A PROF.CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHYAM ULLAL,PT A PROF.CORP
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:
FRONTIER WORKER FITNESS & THERAPY SEVICES
Provider Other Organization Name Type Code:
3
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:
1932398450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2330 SANDALWOOD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL CENTRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92243-3674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-357-8864
Provider Business Mailing Address Fax Number:
760-357-8866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 E 3RD ST
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
CALEXICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92231-2854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-357-8864
Provider Business Practice Location Address Fax Number:
760-357-8866
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ULLAL
Authorized Official First Name:
SHYAM
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
760-357-8864

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT 10423 , 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: WPT10423A . This is a "INDIVDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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