1740506781 NPI number — DEEPAL CEMO MEDICAL SOLUTIONS, LLC

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 1740506781 NPI number — DEEPAL CEMO MEDICAL SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEEPAL CEMO MEDICAL SOLUTIONS, 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:
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:
1740506781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 GLENN DR
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
FOLSOM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95630-3130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-933-2300
Provider Business Mailing Address Fax Number:
916-933-0119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
945 ROSEVILLE PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95678-6063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-788-8444
Provider Business Practice Location Address Fax Number:
916-788-8449
Provider Enumeration Date:
04/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ZWECK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
916-933-2300

Provider Taxonomy Codes

  • Taxonomy code: 261QI0500X , with the licence number:  CLR339743 , 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: 05D2005230 . This is a "CLIA WAIVER" identifier . This identifiers is of the category "OTHER".
  • Identifier: CLR 339743 . This is a "CALIFORNIA CLIA REGISTRATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com