1982877312 NPI number — WHITE MEMORIAL OTOLARYNGOLOGY FOUNDATION

Table of content: (NPI 1982877312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982877312 NPI number — WHITE MEMORIAL OTOLARYNGOLOGY FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE MEMORIAL OTOLARYNGOLOGY FOUNDATION
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:
1982877312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 E CESAR E CHAVEZ AVE
Provider Second Line Business Mailing Address:
SUITE #2300
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90033-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-268-3046
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 E CESAR E CHAVEZ AVE
Provider Second Line Business Practice Location Address:
SUITE #2300
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-268-3046
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VANORE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
323-268-3046

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  G29478 , 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: ZZZ42683Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com