1174698955 NPI number — MRS. CARMEN EMILIA STANISH REGISTERED NURSE08

Table of content: MRS. CARMEN EMILIA STANISH REGISTERED NURSE08 (NPI 1174698955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174698955 NPI number — MRS. CARMEN EMILIA STANISH REGISTERED NURSE08

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANISH
Provider First Name:
CARMEN
Provider Middle Name:
EMILIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE08
Provider Gender Code:
F

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:
1174698955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1725 W 17TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92706-2316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-834-8752
Provider Business Mailing Address Fax Number:
714-834-7956

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PDS 1725 W. 17TH ST.
Provider Second Line Business Practice Location Address:
101E
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-834-8752
Provider Business Practice Location Address Fax Number:
714-834-7956
Provider Enumeration Date:
11/21/2006

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: 163W00000X , with the licence number:  RN363380 , 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)





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