1942262555 NPI number — SIMONIAN SPORTS MEDICINE CLINIC A MEDICAL CORPORATION

Table of content: (NPI 1942262555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942262555 NPI number — SIMONIAN SPORTS MEDICINE CLINIC A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIMONIAN SPORTS MEDICINE CLINIC A MEDICAL CORPORATION
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:
1942262555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 28921
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93729-8921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-228-5448
Provider Business Mailing Address Fax Number:
559-224-3920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
729 NORTH MEDICAL CENTER DRIVE WEST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93611-6880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-439-7633
Provider Business Practice Location Address Fax Number:
559-439-7631
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIMONIAN
Authorized Official First Name:
PETER
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
559-228-4204

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  G83773 , 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