1598049363 NPI number — MISS MARIE ELIZABETH GOESS-SAURAU B.S.

Table of content: JOSEPH PAUL RECTENWALD MD (NPI 1174564488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598049363 NPI number — MISS MARIE ELIZABETH GOESS-SAURAU B.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOESS-SAURAU
Provider First Name:
MARIE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
B.S.
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:
1598049363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3707 SUNSET LANE
Provider Second Line Business Mailing Address:
BAART/CDP, ANTIOCH CLINIC
Provider Business Mailing Address City Name:
ANTIOCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-522-0124
Provider Business Mailing Address Fax Number:
925-522-0133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3707 SUNSET LANE
Provider Second Line Business Practice Location Address:
BAART/CDP, ANTIOCH CLINIC
Provider Business Practice Location Address City Name:
ANTIOCH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-522-0124
Provider Business Practice Location Address Fax Number:
925-522-0133
Provider Enumeration Date:
09/28/2011

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: 103TA0400X , 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)





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