1306816905 NPI number — DEBORAH R RADA PHD

Table of content: DEBORAH R RADA PHD (NPI 1306816905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306816905 NPI number — DEBORAH R RADA PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADA
Provider First Name:
DEBORAH
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1306816905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1651 MENLO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92374-4911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-389-4513
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KAISER PERMANENTE MOB 1, 3C
Provider Second Line Business Practice Location Address:
9985 SIERRA AVE
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-427-5767
Provider Business Practice Location Address Fax Number:
909-427-4425
Provider Enumeration Date:
01/25/2006

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: 170100000X , with the licence number:  NONE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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