Provider Demographics
NPI:1255369260
Name:AXISPT, INC
Entity type:Organization
Organization Name:AXISPT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CLAIMS PROCESSOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CMB
Authorized Official - Phone:213-617-2947
Mailing Address - Street 1:708 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2442
Mailing Address - Country:US
Mailing Address - Phone:213-617-2947
Mailing Address - Fax:213-617-2903
Practice Address - Street 1:708 W 1ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2442
Practice Address - Country:US
Practice Address - Phone:213-617-2947
Practice Address - Fax:213-617-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24988174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66237ZOtherBLUE SHIELD
CAZZZ66237ZOtherBLUE SHIELD