1568657351 NPI number — POLADIAN & MAMIGONIAN

Table of content: (NPI 1568657351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568657351 NPI number — POLADIAN & MAMIGONIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POLADIAN & MAMIGONIAN
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:
1568657351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 O ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FIREBAUGH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93622-2224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-659-9000
Provider Business Mailing Address Fax Number:
559-659-9017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 O ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FIREBAUGH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93622-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-659-9000
Provider Business Practice Location Address Fax Number:
559-659-9017
Provider Enumeration Date:
09/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAMIGONIAN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/PARTNER
Authorized Official Telephone Number:
559-930-9351

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  21046 , 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: ZZZ269732 . This is a "MCARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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