1205257995 NPI number — MS. LYNN MARIA MINERVINI L.AC. MSTOM

Table of content: MS. LYNN MARIA MINERVINI L.AC. MSTOM (NPI 1205257995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205257995 NPI number — MS. LYNN MARIA MINERVINI L.AC. MSTOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINERVINI
Provider First Name:
LYNN
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.AC. MSTOM
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:
1205257995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2882
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEL MAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92014-5882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-391-2346
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12702 VIA CORTINA
Provider Second Line Business Practice Location Address:
SUITE 100D
Provider Business Practice Location Address City Name:
DEL MAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92014-3769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-391-2346
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2013

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: 171100000X , with the licence number:  15663 , 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 © 2007-2024 www.npivalidator.com