1043482599 NPI number — MR. JUSTIN ROBERT MIEIRS C.A.T.C.

Table of content: MR. JUSTIN ROBERT MIEIRS C.A.T.C. (NPI 1043482599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043482599 NPI number — MR. JUSTIN ROBERT MIEIRS C.A.T.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIEIRS
Provider First Name:
JUSTIN
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
C.A.T.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEDINA
Provider Other First Name:
JUSTIN
Provider Other Middle Name:
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:
1043482599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 W. OLYMPIC BLVD.
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-249-9388
Provider Business Mailing Address Fax Number:
213-489-7933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 W. OLYMPIC BLVD.
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-249-9388
Provider Business Practice Location Address Fax Number:
213-489-7933
Provider Enumeration Date:
03/25/2008

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: 101YA0400X , with the licence number:  81568 , 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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