1336327071 NPI number — ANNELIE S PURDY PHD INC

Table of content: (NPI 1336327071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336327071 NPI number — ANNELIE S PURDY PHD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNELIE S PURDY PHD 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:
1336327071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 SOUTH LINCOLN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-349-9706
Provider Business Mailing Address Fax Number:
805-349-0576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 SO LINCOLN STREET
Provider Second Line Business Practice Location Address:
ANNELIE S PURDY PHD INC
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-349-9706
Provider Business Practice Location Address Fax Number:
805-349-0576
Provider Enumeration Date:
02/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PURDY
Authorized Official First Name:
ANNELIE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
805-349-9706

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY5452 , 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)

  • Identifier: 00PL54520 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 151010 . This is a "VALUE OPTION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 6128337 . This is a "BLUE SHIELD UBH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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