1518904077 NPI number — DR. SANJAY AWASTHI M.D.

Table of content: DR. SANJAY AWASTHI M.D. (NPI 1518904077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518904077 NPI number — DR. SANJAY AWASTHI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AWASTHI
Provider First Name:
SANJAY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1518904077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1333 S. MAYFLOWER AVENUE
Provider Second Line Business Mailing Address:
2ND FL
Provider Business Mailing Address City Name:
MONROVIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91016-5266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-775-3514
Provider Business Mailing Address Fax Number:
626-408-3911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 E. DUARTE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUARTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91010-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-256-4673
Provider Business Practice Location Address Fax Number:
626-471-9373
Provider Enumeration Date:
06/01/2006

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: 207RX0202X , with the licence number:  H7117 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: C54833 , 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)

  • Identifier: 138510606 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138510613 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100163170A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138510607 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8R1390 . This is a "BLUE CROSS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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