1447585120 NPI number — CAG GROUP PC

Table of content: (NPI 1447585120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447585120 NPI number — CAG GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAG GROUP PC
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:
1447585120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7095 HOLLYWOOD BLVD
Provider Second Line Business Mailing Address:
SUITE 338
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90028-8903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-927-7364
Provider Business Mailing Address Fax Number:
800-419-7485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1319 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21217-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-927-7364
Provider Business Practice Location Address Fax Number:
800-419-7485
Provider Enumeration Date:
10/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VINCENT
Authorized Official First Name:
MAURICE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
443-927-7364

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  21D0649684 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com