1013105535 NPI number — MARIA LUNA TAN NAVARRO MD INC

Table of content: (NPI 1013105535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013105535 NPI number — MARIA LUNA TAN NAVARRO MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA LUNA TAN NAVARRO MD INC
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:
1013105535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 193
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25321-0193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-965-5888
Provider Business Mailing Address Fax Number:
304-965-3882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
# 5 ELK SHOPPING PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKVIEW
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-965-5888
Provider Business Practice Location Address Fax Number:
304-965-3882
Provider Enumeration Date:
10/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NAVARRO
Authorized Official First Name:
RAMON
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
304-965-5888

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001719991 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: D91205 . This is a "CARELINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2356236 . This is a "UMWA 50 FUNDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4387523 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".