1902045149 NPI number — ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.

Table of content: (NPI 1902045149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902045149 NPI number — ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, 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:
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:
1902045149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1572 RAILROAD AVE
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
SAINT HELENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94574-1169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-968-2809
Provider Business Mailing Address Fax Number:
707-963-9185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 ADAMS ST
Provider Second Line Business Practice Location Address:
106
Provider Business Practice Location Address City Name:
SAINT HELENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94574-1148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-963-4997
Provider Business Practice Location Address Fax Number:
707-963-4990
Provider Enumeration Date:
02/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DONNELLY
Authorized Official First Name:
KAYE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
707-968-2809

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  C32525 , 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 © 2007-2025 www.npivalidator.com