1902075005 NPI number — MGA ENTERPRISES, INC.

Table of content: ANCA-OANA KRANZ MD (NPI 1063456788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902075005 NPI number — MGA ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MGA ENTERPRISES, 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:
PATHWAYS OF NEVADA
Provider Other Organization Name Type Code:
3
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:
1902075005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2980 S RAINBOW BLVD
Provider Second Line Business Mailing Address:
#220 E.
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89146-6531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-219-8788
Provider Business Mailing Address Fax Number:
702-889-4406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2980 S RAINBOW BLVD
Provider Second Line Business Practice Location Address:
#220 E.
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-6531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-219-8788
Provider Business Practice Location Address Fax Number:
702-889-4406
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
MIA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
702-219-8788

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2001155-237 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100507843 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507845 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507846 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507847 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507848 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100508809 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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