1124206891 NPI number — MARIA KAY CAJULIS DME SUPPLIER

Table of content: MARIA KAY CAJULIS DME SUPPLIER (NPI 1124206891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124206891 NPI number — MARIA KAY CAJULIS DME SUPPLIER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAJULIS
Provider First Name:
MARIA
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DME SUPPLIER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PATIENT CARE
Provider Other First Name:
VISITING
Provider Other Middle Name:
ANGELS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124206891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2954 HONOLULU AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CRESCENTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91214-3909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-249-5007
Provider Business Mailing Address Fax Number:
818-279-2285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2954 HONOLULU AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA CRESCENTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91214-3909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-249-5007
Provider Business Practice Location Address Fax Number:
818-279-2285
Provider Enumeration Date:
02/05/2008

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: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6627630001 . This is a "PTAN, ALSO CALLED NSC PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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