1073551446 NPI number — NATIONWIDE MEDICAL, INC.

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 1073551446 NPI number — NATIONWIDE MEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONWIDE MEDICAL, INC.
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:
1073551446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5230 LAS VIRGENES RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALABASAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91302-3447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-338-3500
Provider Business Mailing Address Fax Number:
818-338-3501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5230 LAS VIRGENES RD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALABASAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91302-3447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-338-3500
Provider Business Practice Location Address Fax Number:
818-338-3501
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIEGEL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
818-338-3502

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  45263 , 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: ZZZ66262Z . This is a "BS OF CA PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 104107300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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