1760809099 NPI number — PATRICIA ANN ELBECK RDO, RSLD,RCLD

Table of content: PATRICIA ANN ELBECK RDO, RSLD,RCLD (NPI 1760809099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760809099 NPI number — PATRICIA ANN ELBECK RDO, RSLD,RCLD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELBECK
Provider First Name:
PATRICIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDO, RSLD,RCLD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELBECK
Provider Other First Name:
PATRISHA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDO,RSLD,RCLD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760809099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26012 MARGUERITE PKWY
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92692-3263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-582-3064
Provider Business Mailing Address Fax Number:
949-582-3064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26012 MARGUERITE PKWY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92692-3263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-582-3064
Provider Business Practice Location Address Fax Number:
949-582-3064
Provider Enumeration Date:
03/25/2014

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: 156FX1800X , with the licence number:  SL40066 , 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)





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