1831601731 NPI number — MS. MARY ZUPANCIC NAGASHIMA MFT INTERN

Table of content: MS. MARY ZUPANCIC NAGASHIMA MFT INTERN (NPI 1831601731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831601731 NPI number — MS. MARY ZUPANCIC NAGASHIMA MFT INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZUPANCIC NAGASHIMA
Provider First Name:
MARY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT INTERN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NAGASHIMA
Provider Other First Name:
MARY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT INTERN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831601731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4780 FERRINGTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96003-5378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4780 FERRINGTON CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96003-5378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-262-0068
Provider Business Practice Location Address Fax Number:
530-410-6995
Provider Enumeration Date:
11/01/2017

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: 106H00000X , 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)





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