1124731666 NPI number — KRISTINA INEZ VIEHAUSER NURSE PRACTITIONER,

Table of content: KRISTINA INEZ VIEHAUSER NURSE PRACTITIONER, (NPI 1124731666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124731666 NPI number — KRISTINA INEZ VIEHAUSER NURSE PRACTITIONER,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIEHAUSER
Provider First Name:
KRISTINA
Provider Middle Name:
INEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER,
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:
1124731666
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1893 SUMMERTIME AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMI VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93065-6236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-304-2711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15031 RINALDI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91345-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-365-8051
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2022

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: 363LA2100X , with the licence number:  95023729 , 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: 95023729 . This is a "NP LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".