1144653528 NPI number — CHECK POINT TRANSITION CLINIC, INC.

Table of content: (NPI 1144653528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144653528 NPI number — CHECK POINT TRANSITION CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHECK POINT TRANSITION CLINIC, 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:
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:
1144653528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2611 S COAST HIGHWAY 101
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
CARDIFF
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92007-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-230-2252
Provider Business Mailing Address Fax Number:
760-230-2253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 SANTA FE DR
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-5138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-230-8994
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MACCORMICK
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
760-230-2252

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  C38688 , 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: C38688 . This is a "MEDICAL LINCENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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