1386770857 NPI number — MRS. CHARLENE KAY KRIEG PHD

Table of content: MRS. CHARLENE KAY KRIEG PHD (NPI 1386770857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386770857 NPI number — MRS. CHARLENE KAY KRIEG PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRIEG
Provider First Name:
CHARLENE
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1386770857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5311 SUNCREST ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92807-3717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-637-2319
Provider Business Mailing Address Fax Number:
714-637-1108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 N TUSTIN AVENUE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-637-2319
Provider Business Practice Location Address Fax Number:
714-637-1108
Provider Enumeration Date:
02/26/2007

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: 103T00000X , with the licence number:  PSY13229 , 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: 9248127 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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