1841879996 NPI number — MELISSA ANN AGUILAR-GALCERAN SLP/CCC

Table of content: MELISSA ANN AGUILAR-GALCERAN SLP/CCC (NPI 1841879996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841879996 NPI number — MELISSA ANN AGUILAR-GALCERAN SLP/CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGUILAR-GALCERAN
Provider First Name:
MELISSA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP/CCC
Provider Gender Code:
F

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:
1841879996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52471 AVENIDA MARTINEZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA QUINTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92253-3360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-600-6202
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
87225 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THERMAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92274-8901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-848-1114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2021

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: 235Z00000X , with the licence number:  24528 , 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)





Copyright © 2007-2024 www.npivalidator.com