1619004157 NPI number — OSTEOPATHIC CENTER FOR CHILDREN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619004157 NPI number — OSTEOPATHIC CENTER FOR CHILDREN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSTEOPATHIC CENTER FOR CHILDREN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OSTEOPATHIC CENTER FOR CHILDREN AND FAMILIES
Provider Other Organization Name Type Code:
3
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:
1619004157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3706 RUFFIN RD
Provider Second Line Business Mailing Address:
SUITE 117
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-583-7611
Provider Business Mailing Address Fax Number:
619-583-7611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3706 RUFFIN ROAD
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-583-7611
Provider Business Practice Location Address Fax Number:
619-583-7611
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CENTERS
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OSTEOPATHIC PEDIATRICIAN/ MED. DIR
Authorized Official Telephone Number:
619-583-7611

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com