1306899695 NPI number — UNIVERSITY ADVANCE BIOIMAGING ASSOCIATES

Table of content: MELISSA NICOLE JOHNSTON BCBA, LBA (NPI 1386046498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306899695 NPI number — UNIVERSITY ADVANCE BIOIMAGING ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY ADVANCE BIOIMAGING ASSOCIATES
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:
1306899695
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:
PO BOX 31399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90031-0399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-457-5842
Provider Business Mailing Address Fax Number:
626-457-5843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SAN PABLO ST
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-5313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-442-5940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRANT
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
626-457-5842

Provider Taxonomy Codes

  • Taxonomy code: 2085N0904X , with the licence number:  N/A , 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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