1588730238 NPI number — ANNE ELIZABETH DREJET MD

Table of content: MARGARITA PAZ GARCIA (NPI 1245800630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588730238 NPI number — ANNE ELIZABETH DREJET MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DREJET
Provider First Name:
ANNE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1588730238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93002-2277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-650-5910
Provider Business Mailing Address Fax Number:
805-650-5972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4181 STATE STREET
Provider Second Line Business Practice Location Address:
MEDICAL GROUP PATHOLOGY LAB
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-563-1800
Provider Business Practice Location Address Fax Number:
805-569-6233
Provider Enumeration Date:
11/27/2006

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: 207ZP0102X , with the licence number:  A524340 , 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: 1356409379 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ42967Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A524340 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A524340 . This is a "MEDICAL BOARD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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