1669469615 NPI number — DEAL ENTERPRISES INC

Table of content: (NPI 1669469615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669469615 NPI number — DEAL ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEAL ENTERPRISES INC
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:
1669469615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2950 N SYCAMORE DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SIMI VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-583-1223
Provider Business Mailing Address Fax Number:
805-583-4210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2950 SYCAMORE DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SIMI VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93065-1232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-583-1223
Provider Business Practice Location Address Fax Number:
805-583-4210
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SIEGEL
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
805-583-1223

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY32351 , 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: PHA323510 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1997419 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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