1336565308 NPI number — CHUQUIMIA'S ENTERPRISES INCORPORATED

Table of content: (NPI 1336565308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336565308 NPI number — CHUQUIMIA'S ENTERPRISES INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHUQUIMIA'S ENTERPRISES INCORPORATED
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:
1336565308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16465 PICK PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92504-5641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-789-2948
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16465 PICK PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92504-5641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-789-2948
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CHUQUIMIA
Authorized Official First Name:
LIDIA
Authorized Official Middle Name:
OLGA
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
951-776-9094

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  336408331 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: 336408330 , 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: 90152422A37214 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90874633A85192 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95313448A15047 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90439088A95031 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91847614A05192 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92173381A85048 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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