1235344961 NPI number — RAE STAR HEALTH SYSTEMS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235344961 NPI number — RAE STAR HEALTH SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAE STAR HEALTH SYSTEMS, 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:
1235344961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17215 STUDEBAKER RD.
Provider Second Line Business Mailing Address:
SUITE 175
Provider Business Mailing Address City Name:
CERRITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90703-2256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-865-1340
Provider Business Mailing Address Fax Number:
562-865-1405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17215 STUDEBAKER RD.
Provider Second Line Business Practice Location Address:
SUITE 175
Provider Business Practice Location Address City Name:
CERRITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90703-2556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-865-1340
Provider Business Practice Location Address Fax Number:
562-865-1405
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AFAN
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
ROJAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-881-1091

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 980001554 , 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: 980001554 . This is a "STATE LICENSE" identifier . This identifiers is of the category "OTHER".




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