1801076575 NPI number — E. JAY D. DELAPENHA

Table of content: (NPI 1801076575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801076575 NPI number — E. JAY D. DELAPENHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E. JAY D. DELAPENHA
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:
1801076575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6920 KOLL CENTER PKWY
Provider Second Line Business Mailing Address:
SUITE 222
Provider Business Mailing Address City Name:
PLEASANTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94566-3156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-846-0453
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6920 KOLL CENTER PKWY
Provider Second Line Business Practice Location Address:
SUITE 222
Provider Business Practice Location Address City Name:
PLEASANTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94566-3156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-846-0453
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DELAPENHA
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
925-846-0453

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  103718 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X , with the licence number: 18404 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: DME02584F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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