1134257850 NPI number — STUMP AND AHMADPOUR

Table of content: (NPI 1134257850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134257850 NPI number — STUMP AND AHMADPOUR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STUMP AND AHMADPOUR
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:
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:
1134257850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 801463
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CLARITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91380-1463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-295-0859
Provider Business Mailing Address Fax Number:
866-431-1210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 E SOUTH ST
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90805-4549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-925-8407
Provider Business Practice Location Address Fax Number:
562-925-1723
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AHMADPOUR
Authorized Official First Name:
HED
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
562-925-8407

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  A30282 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RI0011X , with the licence number: A30282 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: A30282 . This is a "PARTNER LICENSE#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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