1134442395 NPI number — DAVID H PAYNE MD INC

Table of content: (NPI 1134442395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134442395 NPI number — DAVID H PAYNE MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID H PAYNE MD INC
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:
1134442395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 465
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92781-0465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-271-9112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1902 ROYALTY DR
Provider Second Line Business Practice Location Address:
#260
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91767-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-397-0833
Provider Business Practice Location Address Fax Number:
909-397-0933
Provider Enumeration Date:
03/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PAYNE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
714-271-9112

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  G62826 , 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)





Copyright © 2007-2025 www.npivalidator.com