1366777617 NPI number — MS. BRENDA SING-OTA L.P.C.C.

Table of content: MS. BRENDA SING-OTA L.P.C.C. (NPI 1366777617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366777617 NPI number — MS. BRENDA SING-OTA L.P.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SING-OTA
Provider First Name:
BRENDA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C.C.
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:
1366777617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10979 REED HARTMAN HWY
Provider Second Line Business Mailing Address:
136B
Provider Business Mailing Address City Name:
BLUE ASH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-2800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-791-7284
Provider Business Mailing Address Fax Number:
513-791-9222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10979 REED HARTMAN HWY
Provider Second Line Business Practice Location Address:
136B
Provider Business Practice Location Address City Name:
BLUE ASH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-791-7284
Provider Business Practice Location Address Fax Number:
513-791-9222
Provider Enumeration Date:
10/05/2009

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: 101YP2500X , with the licence number:  E0700159 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31-0536968 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 01274 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com