1962627448 NPI number — MRS. TERRA MARIE PETRELLA-SHIPMAN MFT

Table of content: MRS. TERRA MARIE PETRELLA-SHIPMAN MFT (NPI 1962627448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962627448 NPI number — MRS. TERRA MARIE PETRELLA-SHIPMAN MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETRELLA-SHIPMAN
Provider First Name:
TERRA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

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:
1962627448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 HEMLOCK AVE
Provider Second Line Business Mailing Address:
#A
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92008-8233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-720-1393
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6994 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 205-B
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92009-4116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-331-3862
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2007

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: 106H00000X , with the licence number:  42006 , 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 © 2007-2025 www.npivalidator.com