1215492434 NPI number — LORRAINE K SOUICE CCAPP

Table of content: LORRAINE K SOUICE CCAPP (NPI 1215492434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215492434 NPI number — LORRAINE K SOUICE CCAPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUICE
Provider First Name:
LORRAINE
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCAPP
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:
1215492434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HEALTHCARE SERVICES INC.
Provider Second Line Business Mailing Address:
3880 ROSECRANS ST.
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-515-0243
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
971 MARLIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92084-5653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-936-1660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2019

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1629439286 . This is a "SUD PROGRAM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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