1275176174 NPI number — DR. ABIGAIL COLLEEN-BOORMAN SERPICO DC

Table of content: DR. ABIGAIL COLLEEN-BOORMAN SERPICO DC (NPI 1275176174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275176174 NPI number — DR. ABIGAIL COLLEEN-BOORMAN SERPICO DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SERPICO
Provider First Name:
ABIGAIL
Provider Middle Name:
COLLEEN-BOORMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOORMAN
Provider Other First Name:
ABIGAIL
Provider Other Middle Name:
COLLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275176174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2511 GARDEN RD # C-11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-5330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-899-5900
Provider Business Mailing Address Fax Number:
831-899-5859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2511 GARDEN RD # C-11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-5330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-899-5900
Provider Business Practice Location Address Fax Number:
831-899-5859
Provider Enumeration Date:
10/23/2019

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: 111N00000X , with the licence number:  34606 , 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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