1467679977 NPI number — WOLBERS AND POREE MEDICAL CORP

Table of content: (NPI 1467679977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467679977 NPI number — WOLBERS AND POREE MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOLBERS AND POREE MEDICAL CORP
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:
1467679977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9057C SOQUEL DR
Provider Second Line Business Mailing Address:
SUITE # A
Provider Business Mailing Address City Name:
APTOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95003-4052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-684-0600
Provider Business Mailing Address Fax Number:
831-684-0606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9057C SOQUEL DR
Provider Second Line Business Practice Location Address:
SUITE # A
Provider Business Practice Location Address City Name:
APTOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95003-4052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-684-0600
Provider Business Practice Location Address Fax Number:
831-684-0606
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOLBERS
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
831-684-0600

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  G80646 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: A66092 , 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)





Copyright © 2007-2025 www.npivalidator.com