1932256211 NPI number — SOUTH COAST ALLERGY & ASTHMA MEDICAL CORPORATION.

Table of content: (NPI 1932256211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932256211 NPI number — SOUTH COAST ALLERGY & ASTHMA MEDICAL CORPORATION.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH COAST ALLERGY & ASTHMA MEDICAL CORPORATION.
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:
1932256211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12370 HESPERIA RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
VICTORVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92395-7719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-245-8645
Provider Business Mailing Address Fax Number:
760-245-6798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12370 HESPERIA RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
VICTORVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92395-7719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-245-8645
Provider Business Practice Location Address Fax Number:
760-245-6798
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AMAR
Authorized Official First Name:
CARMELLA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
760-245-8645

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00G644932 . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1922065788 . This is a "NPI INDIVIDUAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 030003304 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1932256211 . This is a "NPI GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ53231Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2112929 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: BD090Z . This is a "GRP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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