1336403831 NPI number — ST CARMEN HEALTH PROVIDERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336403831 NPI number — ST CARMEN HEALTH PROVIDERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST CARMEN HEALTH PROVIDERS, 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:
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:
1336403831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2060 E ROUTE 66
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
GLENDORA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91740-4691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-335-2167
Provider Business Mailing Address Fax Number:
626-387-9991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2060 E ROUTE 66
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
GLENDORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91740-4691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-335-2167
Provider Business Practice Location Address Fax Number:
866-583-1425
Provider Enumeration Date:
06/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SOTTO
Authorized Official First Name:
ROSEBELLE
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
858-602-6546

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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