1982910295 NPI number — DIABLO NEUROLOGY INC.

Table of content: ERNST JOSEPH NICANORD MD (NPI 1770004004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982910295 NPI number — DIABLO NEUROLOGY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIABLO NEUROLOGY INC.
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:
1982910295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
585 W LOOKOUT RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHOUGAL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98671-7595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-299-9022
Provider Business Mailing Address Fax Number:
925-299-9024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
585 W LOOKOUT RIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHOUGAL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98671-7595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-299-9022
Provider Business Practice Location Address Fax Number:
925-299-9024
Provider Enumeration Date:
08/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
925-299-9022

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  00039405 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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