1164518122 NPI number — CHILDREN'S HEART RHYTHM INSTITUTE, MED. CORP.

Table of content: (NPI 1164518122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164518122 NPI number — CHILDREN'S HEART RHYTHM INSTITUTE, MED. CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HEART RHYTHM INSTITUTE, MED. 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:
CHRI, MED CORP
Provider Other Organization Name Type Code:
5
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:
1164518122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24854
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:
90024-0854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-869-8590
Provider Business Mailing Address Fax Number:
310-479-3147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3740 ATLANTIC AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807-3440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-869-8590
Provider Business Practice Location Address Fax Number:
310-479-3147
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
JOSELYN
Authorized Official Middle Name:
CARMEL
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
310-479-3147

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  G071856 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X , with the licence number: G071856 , 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: 000G71856 . This is a "MEDI-CAL PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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