1710237771 NPI number — JEANNE HATFIELD RD

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 1710237771 NPI number — JEANNE HATFIELD RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATFIELD
Provider First Name:
JEANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HATFIELD
Provider Other First Name:
JEANNE
Provider Other Middle Name:
CHRISITINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710237771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4236 ARCH DR
Provider Second Line Business Mailing Address:
108
Provider Business Mailing Address City Name:
STUDIO CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91604-3210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-235-1111
Provider Business Mailing Address Fax Number:
818-358-4704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4236 ARCH DR
Provider Second Line Business Practice Location Address:
108
Provider Business Practice Location Address City Name:
STUDIO CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91604-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-235-1111
Provider Business Practice Location Address Fax Number:
818-358-4704
Provider Enumeration Date:
09/17/2012

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: 133V00000X , with the licence number:  888692 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)