1063488872 NPI number — JANET K IHDE M.D.

Table of content: JANET K IHDE M.D. (NPI 1063488872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063488872 NPI number — JANET K IHDE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IHDE
Provider First Name:
JANET
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1063488872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2131
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92263-2131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-416-4915
Provider Business Mailing Address Fax Number:
760-416-4916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 N INDIAN CANYON DR STE E150
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-4835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-416-4915
Provider Business Practice Location Address Fax Number:
760-416-4916
Provider Enumeration Date:
02/23/2006

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: 174400000X , with the licence number:  33-0871544 , 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: G381440 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com