1174546626 NPI number — DR. DAVID AUGIE POMMERENCK JR. D.C.

Table of content: DR. DAVID AUGIE POMMERENCK JR. D.C. (NPI 1174546626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174546626 NPI number — DR. DAVID AUGIE POMMERENCK JR. D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POMMERENCK
Provider First Name:
DAVID
Provider Middle Name:
AUGIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1174546626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25095 JEFFERSON AVE STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92562-9107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-894-5006
Provider Business Mailing Address Fax Number:
951-698-8749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2049 PACIFIC COAST HWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LOMITA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90717-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-530-7335
Provider Business Practice Location Address Fax Number:
310-530-3681
Provider Enumeration Date:
07/25/2006

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: 111N00000X , with the licence number:  16484 , 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: 33-0165618 . This is a "TAX ID NO." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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