1629341409 NPI number — ALTERNATIVE MEDICAL MANAGEMENT

Table of content: (NPI 1629341409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629341409 NPI number — ALTERNATIVE MEDICAL MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTERNATIVE MEDICAL MANAGEMENT
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:
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:
1629341409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
526 LEWISHAM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93311-3583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-634-9900
Provider Business Mailing Address Fax Number:
661-634-0973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93215-2263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-634-9900
Provider Business Practice Location Address Fax Number:
661-634-0973
Provider Enumeration Date:
02/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HERRERA
Authorized Official First Name:
RUDY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
661-634-9900

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC21359 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: AC9240 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com