1225256902 NPI number — CENTER POINT, INC

Table of content: (NPI 1225256902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225256902 NPI number — CENTER POINT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER POINT, INC
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:
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:
1225256902
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:
135 PAUL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN RAFAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94903-2023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-492-4444
Provider Business Mailing Address Fax Number:
415-492-8844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11228 FAIR OAKS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIR OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95628-5139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-962-2800
Provider Business Practice Location Address Fax Number:
916-962-2824
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
SUSHMA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
415-492-4444

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  340048AN , 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: 340048AN . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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