1952765182 NPI number — ZEUS DIAGNOSTICS MEDICAL GROUP INC

Table of content: JADE DENAE HUIZENGA PHARMD, B.S., B.A. (NPI 1801181839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952765182 NPI number — ZEUS DIAGNOSTICS MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZEUS DIAGNOSTICS MEDICAL GROUP INC
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:
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:
1952765182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 6646
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CALIFORNIA
Provider Business Mailing Address Postal Code:
92863
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17821 17TH ST
Provider Second Line Business Practice Location Address:
STE #250
Provider Business Practice Location Address City Name:
TUSTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92780-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-505-2093
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HUBBARD
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
Authorized Official Title or Position:
NEUROLOGIST
Authorized Official Telephone Number:
714-505-2093

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G37235 , 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 © 2007-2026 www.npivalidator.com