1689814592 NPI number — MEXICAN AMERICAN ADDICTION PROGRAM, INC.

Table of content: DAVID JAMES HAUSTEIN MD (NPI 1003922873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689814592 NPI number — MEXICAN AMERICAN ADDICTION PROGRAM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEXICAN AMERICAN ADDICTION PROGRAM, 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:
1689814592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4241 FLORIN RD
Provider Second Line Business Mailing Address:
SUITE 65
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95823-2535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-394-2323
Provider Business Mailing Address Fax Number:
916-394-2480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3612 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITES 29
Provider Business Practice Location Address City Name:
NORTH HIGHLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95660-5068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-338-6835
Provider Business Practice Location Address Fax Number:
916-339-1340
Provider Enumeration Date:
03/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CRUZ
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
916-394-3481

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  340004CN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 340004CN , 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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