1184766974 NPI number — CARLOS AMADOR LVN

Table of content: CARLOS AMADOR LVN (NPI 1184766974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184766974 NPI number — CARLOS AMADOR LVN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMADOR
Provider First Name:
CARLOS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LVN
Provider Gender Code:
M

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:
1184766974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 WHITTIER BLVD
Provider Second Line Business Mailing Address:
SUITE 3025
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90023-1307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-639-2500
Provider Business Mailing Address Fax Number:
213-365-2813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
S
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-4303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-639-2500
Provider Business Practice Location Address Fax Number:
213-365-2813
Provider Enumeration Date:
02/12/2007

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: 164X00000X , with the licence number:  VN216407 , 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: VN216407 . This is a "LVN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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