1316486368 NPI number — BELLA NIRVANA CENTER, INC.

Table of content: (NPI 1316486368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316486368 NPI number — BELLA NIRVANA CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLA NIRVANA CENTER, INC.
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:
1316486368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1141 SIBLEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOLSOM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95630-3222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-222-2181
Provider Business Mailing Address Fax Number:
916-414-8605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 PRAIRIE CITY RD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-9592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-222-2181
Provider Business Practice Location Address Fax Number:
916-414-8605
Provider Enumeration Date:
02/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KRISHNA
Authorized Official First Name:
ALOK
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
916-222-2181

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C155199 . This is a "DCA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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