1225164056 NPI number — REPRODUCTIVE HEALTH CARE CENTER

Table of content: (NPI 1225164056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225164056 NPI number — REPRODUCTIVE HEALTH CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REPRODUCTIVE HEALTH CARE CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1225164056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 TULLY RD STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95350-2931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-526-5770
Provider Business Mailing Address Fax Number:
209-544-1234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 TULLY RD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95350-2931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-526-5770
Provider Business Practice Location Address Fax Number:
209-544-1234
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KUMAR
Authorized Official First Name:
ANEETA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
209-526-5770

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , 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)

  • Identifier: FNP336825 . This is a "DEE SCHLANDER, FNP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PA13310 . This is a "LOREN BAUMAN, PA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A31978 . This is a "MICHAEL BRODIE, MD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DO 20A6338 . This is a "LISA HUNT, DO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A17110 . This is a "SAMUEL CHAMPAIGN, MD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: C41165 . This is a "SIVARAMA MADIREDDI, MD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A319780 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G28039 . This is a "PHILLIP KALMAN, MD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: NP12281 . This is a "GLORIA BENNETT, NP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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