1346382348 NPI number — DOROTHY FAYE ALEXANDER

Table of content: (NPI 1346382348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346382348 NPI number — DOROTHY FAYE ALEXANDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOROTHY FAYE ALEXANDER
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:
1346382348
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:
350 PLUMAS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OROVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95966-9241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-589-0536
Provider Business Mailing Address Fax Number:
530-589-1602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3975 HILDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OROVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95966-9588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-589-0536
Provider Business Practice Location Address Fax Number:
530-589-1602
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
DOROTHY
Authorized Official Middle Name:
FAYE
Authorized Official Title or Position:
OWNER LICENSEE
Authorized Official Telephone Number:
530-589-0536

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , 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: LTC60706F . This is a "CA MEDI-CAL VENDOR #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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