1952496523 NPI number — SUZANNE N MAY AUD

Table of content: SAMUEL CANON OD (NPI 1285693473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952496523 NPI number — SUZANNE N MAY AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAY
Provider First Name:
SUZANNE
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
N
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:
1952496523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2725 CAPITAL AVE
Provider Second Line Business Mailing Address:
SUITE 404
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95816-6032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-262-9456
Provider Business Mailing Address Fax Number:
916-262-9460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2725 CAPITAL AVE
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-6032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-262-9456
Provider Business Practice Location Address Fax Number:
916-262-9460
Provider Enumeration Date:
10/03/2006

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: 231H00000X , with the licence number:  AU2324 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237600000X , with the licence number: HA5076 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: MCMG506500 . This is a "WESTERN HEALTH ADVANTAGE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2738517 . This is a "PACIFICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 461869 . This is a "INTERPLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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