1023458239 NPI number — CLAUDIA MARIA RIOS-GASTELUM MA

Table of content: CLAUDIA MARIA RIOS-GASTELUM MA (NPI 1023458239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023458239 NPI number — CLAUDIA MARIA RIOS-GASTELUM MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIOS-GASTELUM
Provider First Name:
CLAUDIA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIOS
Provider Other First Name:
CLAUDIA
Provider Other Middle Name:
MARIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023458239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 600994
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:
92160-0994
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-247-1774
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3510 NEWTON AVE
Provider Second Line Business Practice Location Address:
BUNGALOW 103
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92113-3118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-344-6229
Provider Business Practice Location Address Fax Number:
619-344-6247
Provider Enumeration Date:
07/02/2013

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: 106H00000X , with the licence number:  LMFT 97284 , 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)





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