1760238588 NPI number — REBECCA LYN MORAGNE

Table of content: REBECCA LYN MORAGNE (NPI 1760238588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760238588 NPI number — REBECCA LYN MORAGNE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAGNE
Provider First Name:
REBECCA
Provider Middle Name:
LYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1760238588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 KINGSLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94301-2728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-776-1259
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 LA CASA VIA STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-3092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-939-0300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2024

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: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1509 . This is a "CA BOARD OF NATUROPATHIC MEDICINE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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