1467757740 NPI number — DR. VLADIMIR ANDREY KIYANITSA RPH

Table of content: DR. VLADIMIR ANDREY KIYANITSA RPH (NPI 1467757740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467757740 NPI number — DR. VLADIMIR ANDREY KIYANITSA RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIYANITSA
Provider First Name:
VLADIMIR
Provider Middle Name:
ANDREY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

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:
1467757740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15543 LIVE OAK SPRINGS CANYON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANYON COUNTRY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91387-4721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-409-6402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1841 W AVENUE I
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-1471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-948-1818
Provider Business Practice Location Address Fax Number:
661-948-1919
Provider Enumeration Date:
01/18/2011

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: 183500000X , with the licence number:  60762 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: PR5232 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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