1669811550 NPI number — DA VIGO INC, TMD MEDICAL SOLUTIONS

Table of content: (NPI 1669811550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669811550 NPI number — DA VIGO INC, TMD MEDICAL SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DA VIGO INC, TMD MEDICAL SOLUTIONS
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:
1669811550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 MONOWOOD DR
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:
95630-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-235-3316
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 MONOWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-235-3316
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DA VIGO
Authorized Official First Name:
TAMALA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
916-235-3316

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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)





Copyright © 2007-2024 www.npivalidator.com