1427148204 NPI number — GUNILLA H M PETERSEN-BILLINGS OTR, CHT

Table of content: GUNILLA H M PETERSEN-BILLINGS OTR, CHT (NPI 1427148204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427148204 NPI number — GUNILLA H M PETERSEN-BILLINGS OTR, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERSEN-BILLINGS
Provider First Name:
GUNILLA
Provider Middle Name:
H M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR, CHT
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:
1427148204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 255668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95865-5668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-470-0071
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2702 LOW CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94534-9727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-432-2600
Provider Business Practice Location Address Fax Number:
707-432-2601
Provider Enumeration Date:
10/13/2006

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: 225X00000X , with the licence number:  OT1371 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X , with the licence number: OT1371 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CT0013710 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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