1922499771 NPI number — DONNA C DESSAU FNP-C

Table of content: DONNA C DESSAU FNP-C (NPI 1922499771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922499771 NPI number — DONNA C DESSAU FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESSAU
Provider First Name:
DONNA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1922499771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1874
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUISUN CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94585-4874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
657-241-3600
Provider Business Mailing Address Fax Number:
657-241-7708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19361 BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92648-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-960-4500
Provider Business Practice Location Address Fax Number:
714-960-7133
Provider Enumeration Date:
02/16/2015

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: 363LF0000X , with the licence number:  95002091 , 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)

  • Identifier: CB432684 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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