1942378518 NPI number — MS. KIM LUZENTALES BARRETTO PT

Table of content: MS. KIM LUZENTALES BARRETTO PT (NPI 1942378518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942378518 NPI number — MS. KIM LUZENTALES BARRETTO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRETTO
Provider First Name:
KIM
Provider Middle Name:
LUZENTALES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUZENTALES
Provider Other First Name:
KIM
Provider Other Middle Name:
GIANAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942378518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9333 IMPERIAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90242-2812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-657-6040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 N FRESNO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-2941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-448-5179
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2006

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: 225100000X , with the licence number:  PT27815 , 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)





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