1679775050 NPI number — MRS. MYRTHA DE SALEME MFT

Table of content: MRS. MYRTHA DE SALEME MFT (NPI 1679775050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679775050 NPI number — MRS. MYRTHA DE SALEME MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALEME
Provider First Name:
MYRTHA
Provider Middle Name:
DE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
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:
1679775050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1475 SARATOGA AVE
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95129-4900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-865-0230
Provider Business Mailing Address Fax Number:
408-865-0230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1475 SARATOGA AVE
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95129-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-865-0230
Provider Business Practice Location Address Fax Number:
408-865-0230
Provider Enumeration Date:
06/05/2007

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: 106H00000X , with the licence number:  MFC 31040 , 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)





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