1295812345 NPI number — CHURCH CAPITAL LLC

Table of content: (NPI 1295812345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295812345 NPI number — CHURCH CAPITAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHURCH CAPITAL 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:
6
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:
1295812345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7400 VAN NUYS BLVD
Provider Second Line Business Mailing Address:
UNIT 101
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91405-1966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-997-7000
Provider Business Mailing Address Fax Number:
818-997-7003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7400 VAN NUYS BLVD
Provider Second Line Business Practice Location Address:
UNIT 101
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91405-1966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-997-7000
Provider Business Practice Location Address Fax Number:
818-997-7003
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANOUKIAN
Authorized Official First Name:
ARMEN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER/PIC
Authorized Official Telephone Number:
818-997-7000

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHY51231 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY 51231 , 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)

  • Identifier: 05-67199 . This is a "NCPDP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1295812345 . This is a "MEDI-CAL PROVIDER NUMNER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHY51231 . This is a "CALIFORNIA STATE BOARD OF PHARMACY PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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