1730461864 NPI number — SPECTRUM CULTURAL INSTITUTE INC

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 1730461864 NPI number — SPECTRUM CULTURAL INSTITUTE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRUM CULTURAL INSTITUTE 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:
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:
1730461864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1608 WEST CAMPBELL AVE
Provider Second Line Business Mailing Address:
#313
Provider Business Mailing Address City Name:
CAMPBELL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95008-7300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-873-4543
Provider Business Mailing Address Fax Number:
408-247-1697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1608 W CAMPBELL AVE
Provider Second Line Business Practice Location Address:
#313
Provider Business Practice Location Address City Name:
CAMPBELL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95008-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-873-4543
Provider Business Practice Location Address Fax Number:
405-247-1697
Provider Enumeration Date:
09/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DANIELS
Authorized Official First Name:
MADELINE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
530-873-4543

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY16927 , 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: PSY169270 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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