1831477306 NPI number — BOLLINGER CANYON ANIMAL HOSPITAL INC.

Table of content: DR. MICHAEL LEE PARKER D.C. (NPI 1659522597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831477306 NPI number — BOLLINGER CANYON ANIMAL HOSPITAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOLLINGER CANYON ANIMAL HOSPITAL 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:
1831477306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 MONTGOMERY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN RAMON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94583-4777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-866-8500
Provider Business Mailing Address Fax Number:
877-821-9288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 MONTGOMERY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN RAMON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94583-4777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-866-8500
Provider Business Practice Location Address Fax Number:
877-821-9288
Provider Enumeration Date:
08/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BLOCK
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
VETERINARIAN
Authorized Official Telephone Number:
925-866-8500

Provider Taxonomy Codes

  • Taxonomy code: 174M00000X , with the licence number:  HSP6398 , 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)





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