1477749265 NPI number — CHRISTOPHER A RUZICKA & LAURA LACEY

Table of content: (NPI 1477749265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477749265 NPI number — CHRISTOPHER A RUZICKA & LAURA LACEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER A RUZICKA & LAURA LACEY
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:
1477749265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4180 TREAT BLVD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94518-1858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-682-0319
Provider Business Mailing Address Fax Number:
925-676-0966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4180 TREAT BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94518-1858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-682-0319
Provider Business Practice Location Address Fax Number:
925-676-0966
Provider Enumeration Date:
09/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RUZICKA
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
925-682-0319

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  8844T , 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