1609541044 NPI number — MS. MARAH ISAIAH DE LATORRE PINQUIAN NONE

Table of content: MS. MARAH ISAIAH DE LATORRE PINQUIAN NONE (NPI 1609541044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609541044 NPI number — MS. MARAH ISAIAH DE LATORRE PINQUIAN NONE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINQUIAN
Provider First Name:
MARAH ISAIAH
Provider Middle Name:
DE LATORRE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NONE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAUBAT
Provider Other First Name:
MARAH
Provider Other Middle Name:
ISAIAH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NONE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609541044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18726 S WESTERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90248-3813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-856-0800
Provider Business Mailing Address Fax Number:
855-568-2494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5060 CALIFORNIA AVE STE 610
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:
93309-7073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-258-3240
Provider Business Practice Location Address Fax Number:
855-568-2494
Provider Enumeration Date:
08/09/2021

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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