1285880831 NPI number — MR. DONALD WILLIAM AICHROTH SF IDC

Table of content: MR. DONALD WILLIAM AICHROTH SF IDC (NPI 1285880831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285880831 NPI number — MR. DONALD WILLIAM AICHROTH SF IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AICHROTH
Provider First Name:
DONALD
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
SF IDC
Provider Gender Code:
M

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:
1285880831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BLDG 2496, BAUER ROAD
Provider Second Line Business Mailing Address:
BMC MIRAMAR
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92145-2002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-577-9849
Provider Business Mailing Address Fax Number:
858-577-9965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLDG 2496, BAUER ROAD
Provider Second Line Business Practice Location Address:
BMC MIRAMAR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92145-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-577-9849
Provider Business Practice Location Address Fax Number:
858-577-9965
Provider Enumeration Date:
08/14/2008

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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