1003829060 NPI number — DRANGE HALLMAN MEDICAL CORPORATION

Table of content: (NPI 1003829060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003829060 NPI number — DRANGE HALLMAN MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRANGE HALLMAN MEDICAL CORPORATION
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:
1003829060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2029 VERDUGO BLVD # 781
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91020-1626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-795-2663
Provider Business Mailing Address Fax Number:
973-425-5657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1146 LAVENDER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA CANADA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91011-2339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-795-2663
Provider Business Practice Location Address Fax Number:
973-425-5657
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DRANGE
Authorized Official First Name:
MARLYS
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO/DIRECTOR
Authorized Official Telephone Number:
626-795-2663

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  A54654 , 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: ZZZ05777Z . This is a "BLUE SHIELD PROVIDER NO" identifier . This identifiers is of the category "OTHER".




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