1205125093 NPI number — MRS. SHAHEENA RUBY PATIERNO M.D.

Table of content: MRS. SHAHEENA RUBY PATIERNO M.D. (NPI 1205125093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205125093 NPI number — MRS. SHAHEENA RUBY PATIERNO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATIERNO
Provider First Name:
SHAHEENA
Provider Middle Name:
RUBY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BIELMAN
Provider Other First Name:
SHAHEENA
Provider Other Middle Name:
RUBY
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:
1205125093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 THE CITY DRIVE SOUTH BLDG 1A
Provider Second Line Business Mailing Address:
ROOM 1009 RT 128
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-456-5239
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 THE CITY DRIVE SOUTH BLDG 1A
Provider Second Line Business Practice Location Address:
ROOM 1009 RT 128
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-5239
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2011

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: 207P00000X , with the licence number:  A123688 , 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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