1366601577 NPI number — SUSAN MIKHAELA JALALIAN

Table of content: SUSAN MIKHAELA JALALIAN (NPI 1366601577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366601577 NPI number — SUSAN MIKHAELA JALALIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JALALIAN
Provider First Name:
SUSAN
Provider Middle Name:
MIKHAELA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1366601577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2914 SANDRA PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94303-4015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-219-7697
Provider Business Mailing Address Fax Number:
650-251-9298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2914 SANDRA PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94303-4015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-219-7697
Provider Business Practice Location Address Fax Number:
650-251-9298
Provider Enumeration Date:
06/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835G0303X , with the licence number:  41577 , 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: 41577 . This is a "PHARMACIST LICENSE NBR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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