1689010019 NPI number — PEAK HEALTH SOLUTIONS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689010019 NPI number — PEAK HEALTH SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEAK HEALTH SOLUTIONS
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:
1689010019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 OLD ALABAMA RD
Provider Second Line Business Mailing Address:
SUITE #250
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-2259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-935-6500
Provider Business Mailing Address Fax Number:
858-530-4880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6920 MIRAMAR RD
Provider Second Line Business Practice Location Address:
SUITE #305
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-935-6500
Provider Business Practice Location Address Fax Number:
858-530-4880
Provider Enumeration Date:
05/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
STEIN
Authorized Official First Name:
GABE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESI
Authorized Official Telephone Number:
310-871-8812

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  NP6444 , 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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