1396803896 NPI number — ABTTC, INC.

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 1396803896 NPI number — ABTTC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABTTC, INC.
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:
1396803896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 893507
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMECULA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92589-3507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-990-0340
Provider Business Mailing Address Fax Number:
954-208-5770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41640 CORNING PL
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92562-7048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-517-4849
Provider Business Practice Location Address Fax Number:
800-401-8464
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MENZ
Authorized Official First Name:
JERROD
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-517-4849

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  330071AP , 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: 330071BP . This is a "CA CERTIFICATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 330071AP . This is a "CA LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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