1174661276 NPI number — DR. SHIVIKA DHARAMRUP MA, PSY.D.

Table of content: DR. SHIVIKA DHARAMRUP MA, PSY.D. (NPI 1174661276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174661276 NPI number — DR. SHIVIKA DHARAMRUP MA, PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DHARAMRUP
Provider First Name:
SHIVIKA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MA, PSY.D.
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:
1174661276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 BON AIR RD
Provider Second Line Business Mailing Address:
CRISIS & STABALIZATION UNIT/PES
Provider Business Mailing Address City Name:
GREENBRAE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-499-6666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 ALHAMBRA AVE
Provider Second Line Business Practice Location Address:
CRISIS & STABALIZATION UNIT/PES
Provider Business Practice Location Address City Name:
MARTINEZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94553-3156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-307-4140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2007

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: 103T00000X , with the licence number:  26587 , 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