1942218730 NPI number — JOSE DE GUZMAN CO TING MD INC

Table of content: (NPI 1942218730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942218730 NPI number — JOSE DE GUZMAN CO TING MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSE DE GUZMAN CO TING MD INC
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:
ECHO PARK FAMILY MEDICAL CLINIC
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:
1942218730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2140 CAMINO SAN RAFAEL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-952-4118
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 N LOGAN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-250-7069
Provider Business Practice Location Address Fax Number:
213-250-7520
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CO TING
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
DE GUZMAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
213-250-7069

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  A38825 , 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: 00A388250 . This is a "CHDP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A388250 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com