1982904355 NPI number — DIAZ AGUDA AND DUMULO GENERAL PARTNERSHIP

Table of content: (NPI 1982904355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982904355 NPI number — DIAZ AGUDA AND DUMULO GENERAL PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAZ AGUDA AND DUMULO GENERAL PARTNERSHIP
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:
JADE FAMILY DENTAL CARE
Provider Other Organization Name Type Code:
3
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:
1982904355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13212 HARBOR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92843-1737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-638-9999
Provider Business Mailing Address Fax Number:
714-638-0697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13212 HARBOR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92843-1737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-638-9999
Provider Business Practice Location Address Fax Number:
714-638-0697
Provider Enumeration Date:
11/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ
Authorized Official First Name:
ARCELI
Authorized Official Middle Name:
PEREZ
Authorized Official Title or Position:
DENTIST/PARTNER-OWNER
Authorized Official Telephone Number:
714-638-9999

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  42647 , 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