1780693168 NPI number — CAROL HUMBLE M.D. INC.

Table of content: (NPI 1780693168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780693168 NPI number — CAROL HUMBLE M.D. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROL HUMBLE M.D. 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:
1780693168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 S LAKE AVE
Provider Second Line Business Mailing Address:
535
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91101-3005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-795-6596
Provider Business Mailing Address Fax Number:
626-795-8247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 E SANTA CLARA ST
Provider Second Line Business Practice Location Address:
240
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91006-7226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-254-1800
Provider Business Practice Location Address Fax Number:
626-447-7145
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUMBLE
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-795-6596

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , 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: 00G492410 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G492410 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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