1659533735 NPI number — PARTNER HEALTHCARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659533735 NPI number — PARTNER HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNER HEALTHCARE 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:
INLAND VALLEY CARE
Provider Other Organization Name Type Code:
3
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:
1659533735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4761 ARROW HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTCLAIR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91763-1209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-625-2525
Provider Business Mailing Address Fax Number:
909-625-2500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4761 ARROW HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91763-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-625-2525
Provider Business Practice Location Address Fax Number:
909-625-2500
Provider Enumeration Date:
06/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHANG
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PIC
Authorized Official Telephone Number:
626-590-6666

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  PHY49070 , 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: 1659533735 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5630733 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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