1992958441 NPI number — MRS. DAYNA L TEVIS M.S.

Table of content: MRS. DAYNA L TEVIS M.S. (NPI 1992958441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992958441 NPI number — MRS. DAYNA L TEVIS M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEVIS
Provider First Name:
DAYNA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

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:
1992958441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12598 CENTRAL AVE
Provider Second Line Business Mailing Address:
205
Provider Business Mailing Address City Name:
CHINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91710-3502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-228-0302
Provider Business Mailing Address Fax Number:
909-591-5094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12598 CENTRAL AVE
Provider Second Line Business Practice Location Address:
205
Provider Business Practice Location Address City Name:
CHINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91710-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-228-0302
Provider Business Practice Location Address Fax Number:
909-591-5094
Provider Enumeration Date:
10/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 45292 , 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: 45292 . This is a "LICENSE #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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