1104138742 NPI number — KARIN EVE COLUNGA MSN, RN, CPNP

Table of content: KARIN EVE COLUNGA MSN, RN, CPNP (NPI 1104138742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104138742 NPI number — KARIN EVE COLUNGA MSN, RN, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLUNGA
Provider First Name:
KARIN
Provider Middle Name:
EVE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, CPNP
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:
1104138742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORENO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92552-7270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-486-5700
Provider Business Mailing Address Fax Number:
951-486-5705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 W 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERRIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92570-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-943-4751
Provider Business Practice Location Address Fax Number:
951-657-3522
Provider Enumeration Date:
07/12/2010

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: 363LP0200X , with the licence number:  526820 , 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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