1295291391 NPI number — HUMMINGBIRD HEALTH ORGANIZATION

Table of content: (NPI 1295291391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295291391 NPI number — HUMMINGBIRD HEALTH ORGANIZATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMMINGBIRD HEALTH ORGANIZATION
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:
1295291391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
326 N RIVERSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92376-5926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-875-1464
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23224 WESTWOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND TERRACE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92313-5313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-319-3851
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
TOLEDO
Authorized Official First Name:
MARCELO
Authorized Official Middle Name:
GABRIEL
Authorized Official Title or Position:
PRESIDENT / DENTIST
Authorized Official Telephone Number:
909-319-3851

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com