1477678050 NPI number — MARGUERITE S DEANGELO P.A.

Table of content: MARGUERITE S DEANGELO P.A. (NPI 1477678050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477678050 NPI number — MARGUERITE S DEANGELO P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEANGELO
Provider First Name:
MARGUERITE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1477678050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1615 BUNKER HILL WAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SALINAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93906-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-796-1304
Provider Business Mailing Address Fax Number:
831-757-0291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 CONSTITUTION BLVD
Provider Second Line Business Practice Location Address:
BLDG. 200, FLOOR ONE, SUITE 105
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93906-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-769-8660
Provider Business Practice Location Address Fax Number:
831-769-8655
Provider Enumeration Date:
03/20/2007

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: 163W00000X , with the licence number:  11586 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA15415 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 11586 , 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: FHC70125F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".