1689030512 NPI number — MISS LORETA DE LUNA OSITL CNA

Table of content: MISS LORETA DE LUNA OSITL CNA (NPI 1689030512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689030512 NPI number — MISS LORETA DE LUNA OSITL CNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSITL
Provider First Name:
LORETA
Provider Middle Name:
DE LUNA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CNA
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:
1689030512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7315 STARWARD DR.
Provider Second Line Business Mailing Address:
55
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94568-1861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-760-7130
Provider Business Mailing Address Fax Number:
800-714-1970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7315 STARWARD DR.
Provider Second Line Business Practice Location Address:
55
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94568-1861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-760-7130
Provider Business Practice Location Address Fax Number:
800-714-1970
Provider Enumeration Date:
01/07/2016

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: 376K00000X , with the licence number:  00290581 , 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: BL109529 . This is a "CITY OF DUBLIN BUSINESS LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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