1053653998 NPI number — MAYVELYN YOSALINA ERICHSEN APN

Table of content: MAYVELYN YOSALINA ERICHSEN APN (NPI 1053653998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053653998 NPI number — MAYVELYN YOSALINA ERICHSEN APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERICHSEN
Provider First Name:
MAYVELYN
Provider Middle Name:
YOSALINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOSALINA
Provider Other First Name:
MAYVELYN
Provider Other Middle Name:
DUMAGAT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053653998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 511360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90051-7915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-398-1981
Provider Business Mailing Address Fax Number:
775-398-1984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
781 MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-398-1981
Provider Business Practice Location Address Fax Number:
775-398-1984
Provider Enumeration Date:
03/19/2013

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: 363LF0000X , with the licence number:  APN001501 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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