1093021495 NPI number — DOUGLAS G HAMILTON MEDICAL CORP

Table of content: (NPI 1093021495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093021495 NPI number — DOUGLAS G HAMILTON MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS G HAMILTON MEDICAL CORP
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:
1093021495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12021 WILSHIRE BLVD # 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90025-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-884-7150
Provider Business Mailing Address Fax Number:
818-884-1254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6325 TOPANGA CANYON BLVD STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODLAND HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91367-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-884-7150
Provider Business Practice Location Address Fax Number:
818-884-1254
Provider Enumeration Date:
08/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HAMILTON
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-884-7150

Provider Taxonomy Codes

  • Taxonomy code: 207ND0900X , with the licence number:  G20987 , 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