1932329265 NPI number — DR. MARK LAVERNE JANZEN MD

Table of content: DR. MARK LAVERNE JANZEN MD (NPI 1932329265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932329265 NPI number — DR. MARK LAVERNE JANZEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANZEN
Provider First Name:
MARK
Provider Middle Name:
LAVERNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1932329265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10800 MAGNOLIA AVENUE, MOB1, 2ND FLOOR, MODULE 216
Provider Second Line Business Mailing Address:
KAISER PERMANENTE RIVERSIDE MEDICAL CENTER
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-781-0931
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10800 MAGNOLIA AVENUE,
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE RIVERSIDE MEDICAL CENTER
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-781-0931
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2007

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: 208600000X , with the licence number:  089484 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0127X , with the licence number: 089484 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: A90203 , 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