1881969582 NPI number — DONALD J. JANIUK O.D.

Table of content: (NPI 1881969582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881969582 NPI number — DONALD J. JANIUK O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONALD J. JANIUK O.D.
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:
1881969582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 766
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92074-0766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-748-6210
Provider Business Mailing Address Fax Number:
858-748-6224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12845 POWAY RD
Provider Second Line Business Practice Location Address:
STE 209
Provider Business Practice Location Address City Name:
POWAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92064-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-748-6210
Provider Business Practice Location Address Fax Number:
858-748-6224
Provider Enumeration Date:
03/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JANIUK
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
858-748-6210

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5407TLG , 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: GSD003120 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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