1306464979 NPI number — ALERACARE MEDICAL GROUP OF CALIFORNIA, A MEDICAL CORPORATION

Table of content: DR. JORDAN MICHAEL JACQUEZ MD (NPI 1073035044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306464979 NPI number — ALERACARE MEDICAL GROUP OF CALIFORNIA, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALERACARE MEDICAL GROUP OF CALIFORNIA, A MEDICAL CORPORATION
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:
ALERACARE MEDICAL GROUP OF CALIFORNIA
Provider Other Organization Name Type Code:
3
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:
1306464979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7039 VALJEAN AVE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91406-3915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-609-3123
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4849 VAN NUYS BLVD STE 211
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91403-2127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-209-8874
Provider Business Practice Location Address Fax Number:
833-329-4738
Provider Enumeration Date:
07/10/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LABARBERA
Authorized Official First Name:
MARIANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
888-209-8874

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com