1962683268 NPI number — PORTER RANCH PSYCHIATRIC MEDICAL CORPORATION

Table of content: (NPI 1962683268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962683268 NPI number — PORTER RANCH PSYCHIATRIC MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTER RANCH PSYCHIATRIC MEDICAL CORPORATION
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:
1962683268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7008
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91327-7008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-527-1288
Provider Business Mailing Address Fax Number:
818-428-3237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18250 ROSCOE BLVD STE 245
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-4248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-527-1288
Provider Business Practice Location Address Fax Number:
818-812-9025
Provider Enumeration Date:
11/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KAMAT
Authorized Official First Name:
RAJ
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLER
Authorized Official Telephone Number:
818-527-1288

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A322501 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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