1730414681 NPI number — UMANA CARE LLC.

Table of content: MRS. MARY ANNA EWALT LPC (NPI 1245336858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730414681 NPI number — UMANA CARE LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UMANA CARE LLC.
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:
1730414681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 N BUSH ST
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92706-2852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-568-0048
Provider Business Mailing Address Fax Number:
714-922-6038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 N BUSH ST
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92706-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-568-0048
Provider Business Practice Location Address Fax Number:
714-922-6038
Provider Enumeration Date:
10/10/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUTIERREZ
Authorized Official First Name:
EHKY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
714-673-9208

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  05D2017678 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 550001532 , 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)