1295886067 NPI number — H.D.P.R.G., INC

Table of content: (NPI 1295886067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295886067 NPI number — H.D.P.R.G., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H.D.P.R.G., INC
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:
1295886067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5930 ADOBE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TWENTYNINE PALMS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92277-2356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-367-1743
Provider Business Mailing Address Fax Number:
760-367-1083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5930 ADOBE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92277-2356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-367-1743
Provider Business Practice Location Address Fax Number:
760-367-1083
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
760-367-1743

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: ZZZ07515Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GPT000931 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 678082 . This is a "ACN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GCT000411 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ08136Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GPT000930 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GSP000541 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ07514Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ08126Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GCT000410 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ08135Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GSP000540 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ08125Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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