1942485610 NPI number — ANZA COMMUNITY MEDICAL CENTER CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942485610 NPI number — ANZA COMMUNITY MEDICAL CENTER CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANZA COMMUNITY MEDICAL CENTER CORP
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:
1942485610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56480 HIGHWAY 371
Provider Second Line Business Mailing Address:
P.O. BOX 391313
Provider Business Mailing Address City Name:
ANZA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-763-2626
Provider Business Mailing Address Fax Number:
951-763-5353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56480 HIGHWAY 371
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANZA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-763-2626
Provider Business Practice Location Address Fax Number:
951-763-5353
Provider Enumeration Date:
12/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YUN
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
YUJUNG
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
951-595-5589

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  20A8759 , 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: 00AX87590 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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