1992028708 NPI number — FAVELA DENTAL CORP.

Table of content: MR. CHRISTOPHER ANDREW RODRIGUEZ MA, LPC (NPI 1831546084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992028708 NPI number — FAVELA DENTAL CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAVELA DENTAL CORP.
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:
1992028708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26895 ALISO CREEK RD STE B-712
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALISO VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92656-5301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-499-1200
Provider Business Mailing Address Fax Number:
949-499-2266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26895 ALISO CREEK ROAD, SUITE B-712
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALISO VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92656-5301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-499-1200
Provider Business Practice Location Address Fax Number:
949-499-2266
Provider Enumeration Date:
03/08/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VO
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
949-499-1200

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  42310 , 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)