1821012287 NPI number — DR. MURUGESAMUDALI THANGAVEL M.D.,

Table of content: DR. MURUGESAMUDALI THANGAVEL M.D., (NPI 1821012287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821012287 NPI number — DR. MURUGESAMUDALI THANGAVEL M.D.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THANGAVEL
Provider First Name:
MURUGESAMUDALI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THANGAVEL
Provider Other First Name:
MURUGESAMUDALI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M D
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821012287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43741 SECURE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93536-5861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-949-5366
Provider Business Mailing Address Fax Number:
661-726-6251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 W AVENUE J
Provider Second Line Business Practice Location Address:
NEONATAL INTENSIVE CARE UNIT
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-949-5373
Provider Business Practice Location Address Fax Number:
661-726-6251
Provider Enumeration Date:
07/27/2006

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: 2080N0001X , with the licence number:  A34117 , 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: 00A341170 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com