1497922850 NPI number — DR. MARY ELIZABETH CANTRELL M.D.

Table of content: DR. MARY ELIZABETH CANTRELL M.D. (NPI 1497922850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497922850 NPI number — DR. MARY ELIZABETH CANTRELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTRELL
Provider First Name:
MARY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREEN
Provider Other First Name:
MARY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497922850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 HARBOR BLVD # 313
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93035-4136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-815-4575
Provider Business Mailing Address Fax Number:
805-204-4781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 HARBOR BLVD # 313
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93035-4136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-815-4575
Provider Business Practice Location Address Fax Number:
805-204-4781
Provider Enumeration Date:
05/14/2008

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: 207L00000X , with the licence number:  C43223 , 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)





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