1508910928 NPI number — QUALIUM CORP.

Table of content: (NPI 1508910928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508910928 NPI number — QUALIUM CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALIUM 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:
1508910928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14981 NATIONAL AVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
LOS GATOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95032-2600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-887-6673
Provider Business Mailing Address Fax Number:
866-442-7632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1375 SUTTER ST
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94109-5438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-563-7773
Provider Business Practice Location Address Fax Number:
415-563-7753
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOSTOWFI
Authorized Official First Name:
ANOOSH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
408-499-7597

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ06310Z . This is a "BLUE SHIELD ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7383382 . This is a "AETNA ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ06076Z . This is a "BLUE SHIELD ID# - DME" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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