1609151190 NPI number — MR. ALFRED IGNATIOUS MCADAM MFT INTERN

Table of content: MR. ALFRED IGNATIOUS MCADAM MFT INTERN (NPI 1609151190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609151190 NPI number — MR. ALFRED IGNATIOUS MCADAM MFT INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCADAM
Provider First Name:
ALFRED
Provider Middle Name:
IGNATIOUS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MFT INTERN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCADAM
Provider Other First Name:
ALFRED
Provider Other Middle Name:
IGNATIOUS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFTINTERN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1609151190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3720 ADAMS ST APT 106C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92504-3346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-354-5447
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11951 HESPERIA ROAD
Provider Second Line Business Practice Location Address:
COUNTY OF SAN BERNARDINO
Provider Business Practice Location Address City Name:
HESPERIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-956-2345
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2011

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: 101YP2500X , with the licence number:  60313 , 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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