1962021980 NPI number — GEMMA STELA MENDEZ LEGASPI REGISTERED NURSE

Table of content: GEMMA STELA MENDEZ LEGASPI REGISTERED NURSE (NPI 1962021980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962021980 NPI number — GEMMA STELA MENDEZ LEGASPI REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEGASPI
Provider First Name:
GEMMA STELA
Provider Middle Name:
MENDEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMAS
Provider Other First Name:
GEMMA STELA
Provider Other Middle Name:
LEGASPI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED NURSE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962021980
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1105 N CHAPEL HILL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93611-6757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-392-8031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2615 E CLINTON AVE
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:
93703-2223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-225-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2020

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: 163WM0705X , with the licence number:  840431 , 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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