1295337848 NPI number — JILL SCHULSTAD AZUMA MA, APCC8807

Table of content: JILL SCHULSTAD AZUMA MA, APCC8807 (NPI 1295337848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295337848 NPI number — JILL SCHULSTAD AZUMA MA, APCC8807

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZUMA
Provider First Name:
JILL
Provider Middle Name:
SCHULSTAD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, APCC8807
Provider Gender Code:
F

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:
1295337848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22431 ANTONIO PKWY STE B160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RCHO STA MARG
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92688-3932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-766-7979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 W 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92703-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-972-1402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2020

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: 101YM0800X , with the licence number:  8807 , 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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