1699701391 NPI number — MR. PHILIP JABER

Table of content: MR. PHILIP JABER (NPI 1699701391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699701391 NPI number — MR. PHILIP JABER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JABER
Provider First Name:
PHILIP
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JABER
Provider Other First Name:
PHILIP
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1699701391
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:
2801 ENCINAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMEDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94501-4726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-523-4907
Provider Business Mailing Address Fax Number:
510-523-4580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 ENCINAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-4726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-523-4907
Provider Business Practice Location Address Fax Number:
510-523-4580
Provider Enumeration Date:
06/24/2006

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: 183500000X , with the licence number:  36786 , 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: PHA227100 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com