1427046242 NPI number — KATHERINE PARKER RD

Table of content: KATHERINE PARKER RD (NPI 1427046242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427046242 NPI number — KATHERINE PARKER RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
KATHERINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD
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:
1427046242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2509 CAPITOL AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95816-5808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-455-1155
Provider Business Mailing Address Fax Number:
916-455-1195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2509 CAPITOL AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-5808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-455-1155
Provider Business Practice Location Address Fax Number:
916-455-1195
Provider Enumeration Date:
10/06/2005

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: 133V00000X , with the licence number:  846665 , 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: LICENSE . This is a "846665" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com