1528027232 NPI number — LUIS A MURRAIN D.O.

Table of content: LUIS A MURRAIN D.O. (NPI 1528027232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528027232 NPI number — LUIS A MURRAIN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRAIN
Provider First Name:
LUIS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1528027232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7257 N SIERRA VISTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-341-9729
Provider Business Mailing Address Fax Number:
253-473-6715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7005 N MILBURN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93722-2161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-493-5197
Provider Business Practice Location Address Fax Number:
559-272-2171
Provider Enumeration Date:
03/21/2006

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: 207V00000X , with the licence number:  34-008379 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 10030 , 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: 000000363819 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 8556227 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".