1700835675 NPI number — DR. RONALD O RIGOR M.D.,

Table of content: DR. RONALD O RIGOR M.D., (NPI 1700835675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700835675 NPI number — DR. RONALD O RIGOR M.D.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIGOR
Provider First Name:
RONALD
Provider Middle Name:
O
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,
Provider Gender Code:
M

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:
1700835675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 S ARROYO PKWY
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91105-3263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-844-3884
Provider Business Mailing Address Fax Number:
626-844-3886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 S ARROYO PKWY
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-3263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-844-3884
Provider Business Practice Location Address Fax Number:
626-844-3886
Provider Enumeration Date:
05/09/2006

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: 207N00000X , with the licence number:  36475 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: A92405 , 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: BT689A . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0268292 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: BT687Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 036101791 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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