1780861005 NPI number — NATIONAL MEDICAL ASSOCIATION COMPREHENSIVE HEALTH CENTER

Table of content: (NPI 1780861005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780861005 NPI number — NATIONAL MEDICAL ASSOCIATION COMPREHENSIVE HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL MEDICAL ASSOCIATION COMPREHENSIVE HEALTH CENTER
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:
6
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:
1780861005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
446 26TH ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92102-3026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-231-3200
Provider Business Mailing Address Fax Number:
619-231-3212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 ELM ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-235-4211
Provider Business Practice Location Address Fax Number:
619-235-4517
Provider Enumeration Date:
01/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OWENS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CEO & CMO
Authorized Official Telephone Number:
619-231-3200

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  090000618 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , with the licence number: 090000618 , 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: BCP70794F . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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