1669731899 NPI number — FOLSOM DERMATOLOGY

Table of content: SELMA APARECIDA MARTINS BARBOSA PTA (NPI 1710200340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669731899 NPI number — FOLSOM DERMATOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOLSOM DERMATOLOGY
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:
1669731899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1745 CREEKSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOLSOM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95630-3924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-983-2302
Provider Business Mailing Address Fax Number:
916-983-2382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1745 CREEKSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-983-2302
Provider Business Practice Location Address Fax Number:
916-983-2382
Provider Enumeration Date:
05/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SATTERFIELD
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
916-983-2302

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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