1831527316 NPI number — MLSG CORP

Table of content: ERIKA ELAINE DOXTADER M.D. (NPI 1023255064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831527316 NPI number — MLSG CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MLSG CORP
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:
6
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:
1831527316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23331 EL TORO RD
Provider Second Line Business Mailing Address:
SUITE 217 B
Provider Business Mailing Address City Name:
LAKE FOREST
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92630-4891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-707-5059
Provider Business Mailing Address Fax Number:
949-203-2177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13331 EL TORO ROAD
Provider Second Line Business Practice Location Address:
SUITE 217 B
Provider Business Practice Location Address City Name:
LAKE FOREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-707-5059
Provider Business Practice Location Address Fax Number:
949-203-2177
Provider Enumeration Date:
10/22/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
SHAUN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-707-5059

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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