1265769632 NPI number — MM UNLIMITED INC.

Table of content: (NPI 1265769632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265769632 NPI number — MM UNLIMITED INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MM UNLIMITED 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:
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:
1265769632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3811 FLORIN RD
Provider Second Line Business Mailing Address:
SUITE 26
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95823-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-421-1184
Provider Business Mailing Address Fax Number:
916-421-1188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2315 34TH ST
Provider Second Line Business Practice Location Address:
ROOM E21, E25 & E26A
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-421-1184
Provider Business Practice Location Address Fax Number:
916-421-1188
Provider Enumeration Date:
11/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PROGRAM ADMINISTRATOR
Authorized Official Telephone Number:
916-421-1184

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 343471 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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