1154634962 NPI number — MR. GERALD BICERA LAVARIAS B.C.B.A.

Table of content: MR. GERALD BICERA LAVARIAS B.C.B.A. (NPI 1154634962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154634962 NPI number — MR. GERALD BICERA LAVARIAS B.C.B.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAVARIAS
Provider First Name:
GERALD
Provider Middle Name:
BICERA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
B.C.B.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAVARIAS
Provider Other First Name:
GERALD
Provider Other Middle Name:
BICERA
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BCBA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1154634962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 MING AVE
Provider Second Line Business Mailing Address:
SUITE # 228
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-397-4777
Provider Business Mailing Address Fax Number:
661-397-4277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 MING AVE
Provider Second Line Business Practice Location Address:
SUITE # 228
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-397-4777
Provider Business Practice Location Address Fax Number:
661-397-4277
Provider Enumeration Date:
07/21/2010

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: 103K00000X , with the licence number:  1-10-7159 , 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