1992179634 NPI number — GARDNER SOLAR PSYCHOLOGY CENTER

Table of content: (NPI 1992179634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992179634 NPI number — GARDNER SOLAR PSYCHOLOGY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARDNER SOLAR PSYCHOLOGY CENTER
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:
1992179634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 YAMATO RD
Provider Second Line Business Mailing Address:
STE 106-333
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431-4704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-414-1650
Provider Business Mailing Address Fax Number:
561-423-7961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1499 W PALMETTO PARK RD
Provider Second Line Business Practice Location Address:
STE 172
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33486-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-414-1650
Provider Business Practice Location Address Fax Number:
561-423-7961
Provider Enumeration Date:
11/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GARDNER-SCHAUDER
Authorized Official First Name:
LEORA
Authorized Official Middle Name:
JOSEPHA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
561-414-1650

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY5116 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: PY5116 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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