1760529176 NPI number — ROGER G ANNABEL MD

Table of content: ROGER G ANNABEL MD (NPI 1760529176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760529176 NPI number — ROGER G ANNABEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANNABEL
Provider First Name:
ROGER
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1760529176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4653 TORREY PINES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINO HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91709-3388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-994-5987
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11705 SLATE AVE
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-351-1364
Provider Business Practice Location Address Fax Number:
951-359-3748
Provider Enumeration Date:
02/01/2007

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: 208D00000X , with the licence number:  A53036 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: A53036 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0505X , with the licence number: A53036 , 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)





Copyright © 2007-2025 www.npivalidator.com