1952422727 NPI number — DR. JOAN V ABBOTT PHARMD

Table of content: DR. JOAN V ABBOTT PHARMD (NPI 1952422727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952422727 NPI number — DR. JOAN V ABBOTT PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABBOTT
Provider First Name:
JOAN
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIELSEN
Provider Other First Name:
JOAN
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952422727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9854 FOX VALLEY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92127-3405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-312-1097
Provider Business Mailing Address Fax Number:
858-312-1087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 W WASHINGTON AVE
Provider Second Line Business Practice Location Address:
RITE-AID #5629
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-746-2263
Provider Business Practice Location Address Fax Number:
760-746-0549
Provider Enumeration Date:
04/02/2007

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: 183500000X , with the licence number:  28721 , 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)