1629022561 NPI number — MC IBANEZ MEDICAL CORPORATION

Table of content: (NPI 1629022561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629022561 NPI number — MC IBANEZ MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MC IBANEZ MEDICAL CORPORATION
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:
Provider Other Organization Name Type Code:
6
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:
1629022561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8100 TIMBERLAKE WAY
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95823-5409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-681-5000
Provider Business Mailing Address Fax Number:
916-681-5887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8100 TIMBERLAKE WAY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-681-5000
Provider Business Practice Location Address Fax Number:
916-681-5887
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IBANEZ
Authorized Official First Name:
CAESAR
Authorized Official Middle Name:
LOCSIN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
916-681-5000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A64505 , 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: 00A645050 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com