1790172104 NPI number — JERI YVONNE MOVEMENT DISORDERS NEUROLOGY 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 1790172104 NPI number — JERI YVONNE MOVEMENT DISORDERS NEUROLOGY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERI YVONNE MOVEMENT DISORDERS NEUROLOGY 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:
1790172104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8327 BRIMHALL RD STE 703
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93312-2250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-679-3590
Provider Business Mailing Address Fax Number:
661-695-6900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8327 BRIMHALL RD STE 703
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93312-2250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-679-3590
Provider Business Practice Location Address Fax Number:
661-695-6900
Provider Enumeration Date:
04/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JERI
Authorized Official Middle Name:
YVONNE
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
661-679-3590

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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