1356581847 NPI number — KATHRYN RIGONAN MD INC A PROFESSIONAL CORPORATION

Table of content: (NPI 1356581847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356581847 NPI number — KATHRYN RIGONAN MD INC A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHRYN RIGONAN MD INC A PROFESSIONAL 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:
1356581847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11100 WARNER AVE
Provider Second Line Business Mailing Address:
SUITE 154
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-7506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-754-0100
Provider Business Mailing Address Fax Number:
714-754-6806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11100 WARNER AVE
Provider Second Line Business Practice Location Address:
SUITE 154
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-7506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-754-0100
Provider Business Practice Location Address Fax Number:
714-754-6806
Provider Enumeration Date:
02/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RIGONAN
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
RUBIO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-754-0100

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A51220 , 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: 1336234210 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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