1962528893 NPI number — DAFTINC AND STAMOS INC

Table of content: (NPI 1962528893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962528893 NPI number — DAFTINC AND STAMOS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAFTINC AND STAMOS 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:
1962528893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 K ST
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95816-5114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-441-3925
Provider Business Mailing Address Fax Number:
916-441-2855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 K ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-5114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-441-3925
Provider Business Practice Location Address Fax Number:
916-441-2855
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAFT
Authorized Official First Name:
KENT
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
919-441-3925

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  22335 , 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: 22335 . This is a "LICENSEKSDAFT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 28244 . This is a "LICENSECTSTAMOS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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