1225544927 NPI number — JACQUELYN NICOLE BAUMGARTNER HAD

Table of content: JACQUELYN NICOLE BAUMGARTNER HAD (NPI 1225544927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225544927 NPI number — JACQUELYN NICOLE BAUMGARTNER HAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUMGARTNER
Provider First Name:
JACQUELYN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HAD
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:
1225544927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5555 GARDEN GROVE BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92683-8234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-898-5732
Provider Business Mailing Address Fax Number:
714-901-4058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3808 W RIVERSIDE DR STE 402
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91505-5301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-842-4069
Provider Business Practice Location Address Fax Number:
818-848-1616
Provider Enumeration Date:
12/18/2017

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: 237700000X , with the licence number:  HA8290 , 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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