1760794002 NPI number — SIA TECH, 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 1760794002 NPI number — SIA TECH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIA TECH, 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:
1760794002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 ESCONDIDO AVE STE 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92084-6170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2611 TEMPLE HEIGHTS DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92056-3582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-631-3422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RENNER
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF BUSINESS OFFICIAL
Authorized Official Telephone Number:
760-631-3422

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  3768452 , 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)