1336174366 NPI number — THE NIRAV C NAIK MEDICAL CORPORATION

Table of content: (NPI 1336174366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336174366 NPI number — THE NIRAV C NAIK MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NIRAV C NAIK 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:
VALLEY ADVANCED SURGICAL
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:
1336174366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4817 CENTENNIAL PLAZA WAY
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93312-1957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-447-4559
Provider Business Mailing Address Fax Number:
661-447-4565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4817 CENTENNIAL PLAZA WAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93312-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-447-4559
Provider Business Practice Location Address Fax Number:
661-447-4565
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NAIK
Authorized Official First Name:
NIRAV
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
661-447-4559

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  A67017 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P00072923 . This is a "PALMETTO GBA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A670170 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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