1073044236 NPI number — ALIGN FOOT AND ANKLE CENTER INC A

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073044236 NPI number — ALIGN FOOT AND ANKLE CENTER INC A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALIGN FOOT AND ANKLE CENTER INC A
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:
1073044236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2460 N PONDEROSA DR STE A105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93010-2375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-482-0711
Provider Business Mailing Address Fax Number:
805-482-6524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2460 N PONDEROSA DR
Provider Second Line Business Practice Location Address:
A-105
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93010-2398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-482-0711
Provider Business Practice Location Address Fax Number:
805-482-6524
Provider Enumeration Date:
03/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PENG
Authorized Official First Name:
HAI-EN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
805-482-0711

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  E4368 , 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)





Copyright © 2007-2025 www.npivalidator.com