=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811239742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STG INTERNATIONAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2013
-----------------------------------------------------
Last Update Date | 03/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 266 W ALLEN ST
-----------------------------------------------------
City | BRAWLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92227-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-960-7819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 266 W ALLEN ST
-----------------------------------------------------
City | BRAWLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92227-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LVN
-----------------------------------------------------
Name | MS. ANGELINA A DURAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-336-4648
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------