1104930478 NPI number — BRADEN PARTNERS LP

Table of content: (NPI 1104930478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104930478 NPI number — BRADEN PARTNERS LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRADEN PARTNERS LP
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:
6
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:
1104930478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8730 HARRIS RD
Provider Second Line Business Mailing Address:
UNIT 204
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93311-8990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-396-3720
Provider Business Mailing Address Fax Number:
661-832-6009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16031 ARROW HWY
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
IRWINDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91706-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-851-8503
Provider Business Practice Location Address Fax Number:
626-851-9070
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
JANE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
415-893-1518

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DME03108F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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