1750450169 NPI number — MR. JOHN M MIGUELEZ CP

Table of content: MR. JOHN M MIGUELEZ CP (NPI 1750450169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750450169 NPI number — MR. JOHN M MIGUELEZ CP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIGUELEZ
Provider First Name:
JOHN
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CP
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:
1750450169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 W TORRANCE BLVD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
REDONDO BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90277-3610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-372-3050
Provider Business Mailing Address Fax Number:
310-372-3057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WRAMC SUITE 3H
Provider Second Line Business Practice Location Address:
6900 GEORGIA AVE NW
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20307-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-782-9830
Provider Business Practice Location Address Fax Number:
202-782-4365
Provider Enumeration Date:
11/07/2006

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: 247200000X , with the licence number:  CP001751 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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