1578850434 NPI number — MARICEL ISIDRO-REIGHARD NURSING ANESTHESIA INC

Table of content: CLINTON SAGO (NPI 1740430081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578850434 NPI number — MARICEL ISIDRO-REIGHARD NURSING ANESTHESIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARICEL ISIDRO-REIGHARD NURSING ANESTHESIA INC
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:
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:
1578850434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 HOLLAND STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-2568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-588-2190
Provider Business Mailing Address Fax Number:
949-588-2199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15201 VIA NAPOLI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93306-9412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-578-7273
Provider Business Practice Location Address Fax Number:
949-588-2199
Provider Enumeration Date:
06/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ISIDRO-REIGHARD
Authorized Official First Name:
MARICEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-588-2190

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  3527 , 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)





Copyright © 2007-2025 www.npivalidator.com