1245210368 NPI number — MR. JOHNNY L TRIPLETT MD

Table of content: MR. JOHNNY L TRIPLETT MD (NPI 1245210368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245210368 NPI number — MR. JOHNNY L TRIPLETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIPLETT
Provider First Name:
JOHNNY
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRIPLETT
Provider Other First Name:
JOHNNY
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245210368
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3811 WYNDHAM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-834-3929
Provider Business Mailing Address Fax Number:
661-834-2925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4674 EAST BARKER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-930-9059
Provider Business Practice Location Address Fax Number:
562-930-9059
Provider Enumeration Date:
01/17/2006

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: 207L00000X , with the licence number:  A53390 , 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: 00A53390 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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