1992899942 NPI number — PEDIATRIC & ADOLESCENT MEDICAL ASSOC. OF THE PACIFIC COAST

Table of content: MRS. DEBRA ALICE OMER RPH (NPI 1821153222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992899942 NPI number — PEDIATRIC & ADOLESCENT MEDICAL ASSOC. OF THE PACIFIC COAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC & ADOLESCENT MEDICAL ASSOC. OF THE PACIFIC COAST
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:
1992899942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 SAN JOSE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93901-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-757-8124
Provider Business Mailing Address Fax Number:
731-757-4790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 SAN JOSE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93901-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-757-8124
Provider Business Practice Location Address Fax Number:
731-757-4790
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLOUGH
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
CAO
Authorized Official Telephone Number:
831-757-8124

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR009600 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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