1932733243 NPI number — A STEP ABOVE, LLC

Table of content: DR. GORDON W. MARSH DDS (NPI 1104030840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932733243 NPI number — A STEP ABOVE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A STEP ABOVE, LLC
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:
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:
1932733243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2111 OCEAN AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-981-8713
Provider Business Mailing Address Fax Number:
925-848-3614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3648 DELTA FAIR BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTIOCH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-481-2189
Provider Business Practice Location Address Fax Number:
925-848-3614
Provider Enumeration Date:
02/25/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANZANO
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
HENRY
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
408-981-8713

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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