1538498324 NPI number — MELISSA ANN GARAFALO-CULMER AU.D.

Table of content: MELISSA ANN GARAFALO-CULMER AU.D. (NPI 1538498324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538498324 NPI number — MELISSA ANN GARAFALO-CULMER AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARAFALO-CULMER
Provider First Name:
MELISSA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARAFALO
Provider Other First Name:
MELISSA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AU.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538498324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 ADOLFO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93012-6792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-437-1380
Provider Business Mailing Address Fax Number:
805-389-4297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 ADOLFO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93012-6792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-437-1380
Provider Business Practice Location Address Fax Number:
805-389-4297
Provider Enumeration Date:
12/08/2009

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: 231H00000X , with the licence number:  AUD575 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: AU2826 , 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: 76308529 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020615 . This is a "KAISER COMMERCIAL NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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