1356377394 NPI number — LENITY CORPORATION

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 1356377394 NPI number — LENITY CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LENITY 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:
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:
1356377394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17777 CENTER COURT DRIVE
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
CERRITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90703-8569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-403-8877
Provider Business Mailing Address Fax Number:
562-403-8874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17777 CENTER COURT DRIVE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
CERRITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90703-8569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-403-8877
Provider Business Practice Location Address Fax Number:
562-403-8874
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAUTISTA
Authorized Official First Name:
JONE JADE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
562-403-8877

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  9830001073 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 980001073 , 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: NONE . This is a "PRIVATE INSURANCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: NONE , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 058371 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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