1649257148 NPI number — ELEONORA S SPOKOYNY MD

Table of content: ELEONORA S SPOKOYNY MD (NPI 1649257148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649257148 NPI number — ELEONORA S SPOKOYNY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPOKOYNY
Provider First Name:
ELEONORA
Provider Middle Name:
S
Provider Name Prefix Text:
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:
1649257148
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25982 PALA
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-6719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-586-5500
Provider Business Mailing Address Fax Number:
949-586-1600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25982 PALA
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-586-5500
Provider Business Practice Location Address Fax Number:
949-586-1600
Provider Enumeration Date:
12/27/2005

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: 2084N0400X , with the licence number:  A53662 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P2900X , with the licence number: A53662 , 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)

  • Identifier: A0536620 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com