1508083460 NPI number — MRS. ANNE MARGARET AHLMAN MPT

Table of content: MRS. ANNE MARGARET AHLMAN MPT (NPI 1508083460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508083460 NPI number — MRS. ANNE MARGARET AHLMAN MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHLMAN
Provider First Name:
ANNE
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
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:
1508083460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
386 PISMO TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94086-5972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-773-0656
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1054 S DE ANZA BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95129-3553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-873-8188
Provider Business Practice Location Address Fax Number:
408-873-8138
Provider Enumeration Date:
04/19/2007

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: 225100000X , with the licence number:  18788 , 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)





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