1285228577 NPI number — AHCS HIV & CHRONIC CLINICAL CARE LLC

Table of content: KARMEL LAURENE MAYO ALC (NPI 1528627171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285228577 NPI number — AHCS HIV & CHRONIC CLINICAL CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AHCS HIV & CHRONIC CLINICAL CARE LLC
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:
1285228577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26024 ACERO STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-2768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12665 GARDEN GROVE BLVD STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92843-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-973-8560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SHERMAN
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
949-973-8560

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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