1154836542 NPI number — NESTOR AARON CANADA-ZARAGOZA

Table of content: NESTOR AARON CANADA-ZARAGOZA (NPI 1154836542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154836542 NPI number — NESTOR AARON CANADA-ZARAGOZA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANADA-ZARAGOZA
Provider First Name:
NESTOR
Provider Middle Name:
AARON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZARAGOZA
Provider Other First Name:
NESTOR
Provider Other Middle Name:
AARON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154836542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/30/2021
NPI Reactivation Date:
09/30/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1911 WILLIAMS DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93036-0673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-289-0120
Provider Business Mailing Address Fax Number:
805-981-9250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1911 WILLIAMS DRIVE SUITE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-981-9250
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2017

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: 104100000X , with the licence number:  103136 , 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: 56CC . This is a "ASPIRA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".