1962716076 NPI number — ASHLEY ROSE DANSEY P.T.

Table of content: ASHLEY ROSE DANSEY P.T. (NPI 1962716076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962716076 NPI number — ASHLEY ROSE DANSEY P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANSEY
Provider First Name:
ASHLEY
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DURON
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962716076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3070 MADISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92008-2310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-591-7750
Provider Business Mailing Address Fax Number:
760-294-9813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9830 PROSPECT AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-4375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-448-4860
Provider Business Practice Location Address Fax Number:
619-448-1639
Provider Enumeration Date:
07/30/2010

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: 225100000X , with the licence number:  PT 36952 , 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: ED668X . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ED668Y . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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