1275864910 NPI number — ABC CHILDREN'S CLINIC 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 1275864910 NPI number — ABC CHILDREN'S CLINIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABC CHILDREN'S CLINIC 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:
1275864910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26730 TOWNE CENTRE DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
FOOTHILL RANCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92610-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-380-1234
Provider Business Mailing Address Fax Number:
949-305-2230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26730 TOWNE CENTRE DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
FOOTHILL RANCH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92610-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-380-1234
Provider Business Practice Location Address Fax Number:
949-305-2230
Provider Enumeration Date:
01/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MONFARED
Authorized Official First Name:
MARJAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-380-1234

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  G078954 , 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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