1588856801 NPI number — ELIZABETH HANSEN D.P.T.

Table of content: ELIZABETH HANSEN D.P.T. (NPI 1588856801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588856801 NPI number — ELIZABETH HANSEN D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSEN
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARAND
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588856801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 S ANDREASEN DR
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92029-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-591-7750
Provider Business Mailing Address Fax Number:
760-294-9813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 W SAN MARCOS BLVD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92078-1142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-471-2440
Provider Business Practice Location Address Fax Number:
760-471-2442
Provider Enumeration Date:
08/10/2007

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: 225100000X , with the licence number:  34757 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT 9685 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BS311X . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BS311Z . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 809981 . This is a "MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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