1104885300 NPI number — JOHN C NINOS MD

Table of content: JOHN C NINOS MD (NPI 1104885300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104885300 NPI number — JOHN C NINOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NINOS
Provider First Name:
JOHN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1104885300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4791 E PALM CANYON DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92264-5220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-834-7930
Provider Business Mailing Address Fax Number:
760-834-7931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4791 E PALM CANYON DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92264-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-834-7930
Provider Business Practice Location Address Fax Number:
760-834-7931
Provider Enumeration Date:
03/17/2006

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: 207Q00000X , with the licence number:  MD025659E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: G88658 , 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: 50055533 . This is a "CAPITOL BC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018716640001 . This is a "MEDICAID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1772699 . This is a "HIGHMARK BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com