1174629984 NPI number — RANI K FALCONER RN NP

Table of content: RANI K FALCONER RN NP (NPI 1174629984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174629984 NPI number — RANI K FALCONER RN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALCONER
Provider First Name:
RANI
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOKATNUR
Provider Other First Name:
RANI
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174629984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 N. SAN ANTONIO ROAD
Provider Second Line Business Mailing Address:
FIRST FLOOR, ROOM 107
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93110-1316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-681-5461
Provider Business Mailing Address Fax Number:
805-681-5200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 NORTH R STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOMPOC
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93436-5226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-737-6400
Provider Business Practice Location Address Fax Number:
805-737-6458
Provider Enumeration Date:
09/16/2006

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: 363LP0200X , with the licence number:  9645 , 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: CB241739 . This is a "MEDICARE ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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