1487616777 NPI number — MS. MIRIAM ELON PLASS RN

Table of content: MS. MIRIAM ELON PLASS RN (NPI 1487616777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487616777 NPI number — MS. MIRIAM ELON PLASS RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLASS
Provider First Name:
MIRIAM
Provider Middle Name:
ELON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAINES
Provider Other First Name:
MIRIAM
Provider Other Middle Name:
ELON
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487616777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36851 HAYWARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARSTOW
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92311-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-380-6027
Provider Business Mailing Address Fax Number:
760-380-5861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USA- MEDDAC ATTN: MCXK-PM-CHN
Provider Second Line Business Practice Location Address:
BOX 105109
Provider Business Practice Location Address City Name:
FORT IRWIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-380-6027
Provider Business Practice Location Address Fax Number:
760-380-5861
Provider Enumeration Date:
04/04/2006

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: 163W00000X , with the licence number:  654477 , 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)