1790891604 NPI number — MS. MARGARET M BEDRIN MARRIAGE FAM THPST

Table of content: MS. MARGARET M BEDRIN MARRIAGE FAM THPST (NPI 1790891604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790891604 NPI number — MS. MARGARET M BEDRIN MARRIAGE FAM THPST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEDRIN
Provider First Name:
MARGARET
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MARRIAGE FAM THPST
Provider Gender Code:
F

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:
1790891604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX #3605
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-825-1187
Provider Business Mailing Address Fax Number:
925-825-7430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1280 BOULEVARD WAY
Provider Second Line Business Practice Location Address:
#308
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-825-1187
Provider Business Practice Location Address Fax Number:
925-825-7430
Provider Enumeration Date:
08/22/2006

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: 103T00000X , with the licence number:  28904 , 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: 18935634 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7368119 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 066495 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101684 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".




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