1629022363 NPI number — DR. RUTH PRANGE TROTTER MD

Table of content: DR. RUTH PRANGE TROTTER MD (NPI 1629022363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629022363 NPI number — DR. RUTH PRANGE TROTTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROTTER
Provider First Name:
RUTH
Provider Middle Name:
PRANGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1629022363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1615 BUNKER HILL WAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SALINAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93906-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-796-1304
Provider Business Mailing Address Fax Number:
831-757-0291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 FREMONT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEASIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93955-5715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-899-8100
Provider Business Practice Location Address Fax Number:
831-899-8105
Provider Enumeration Date:
05/19/2006

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: 207R00000X , with the licence number:  A71474 , 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)

  • Identifier: ZZZ15686Z . This is a "MEDICARE GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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