1982790960 NPI number — MRS. DANI SKEIE JANZEN MPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982790960 NPI number — MRS. DANI SKEIE JANZEN MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANZEN
Provider First Name:
DANI
Provider Middle Name:
SKEIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SKEIE
Provider Other First Name:
DANI
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982790960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16602 SELL CIRCLE
Provider Second Line Business Mailing Address:
#50
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-798-4026
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10900 WARNER AVE
Provider Second Line Business Practice Location Address:
#111
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-964-3337
Provider Business Practice Location Address Fax Number:
714-964-8806
Provider Enumeration Date:
10/05/2006

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:  PT32551 , 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: WPT32551A . This is a "MEDICARE PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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