1013969153 NPI number — EMERGENCY PHYSICIANS ASSOCIATES OVERHEAD OPERATING ACCOUNT DENNIS BELO

Table of content: (NPI 1013969153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013969153 NPI number — EMERGENCY PHYSICIANS ASSOCIATES OVERHEAD OPERATING ACCOUNT DENNIS BELO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY PHYSICIANS ASSOCIATES OVERHEAD OPERATING ACCOUNT DENNIS BELO
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:
6
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:
1013969153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4419
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91365-4419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-620-3100
Provider Business Mailing Address Fax Number:
818-587-2493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2105 FOREST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-947-2500
Provider Business Practice Location Address Fax Number:
818-587-2493
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JADALLAH
Authorized Official First Name:
SAMI
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
408-947-2500

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0017960 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com