1073897096 NPI number — MS. SVETLANA ZOLOTUKHINA F.N.P

Table of content: MS. SVETLANA ZOLOTUKHINA F.N.P (NPI 1073897096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073897096 NPI number — MS. SVETLANA ZOLOTUKHINA F.N.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZOLOTUKHINA
Provider First Name:
SVETLANA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
F.N.P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZOLOTUKHINA
Provider Other First Name:
SVETLANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
F.N.P
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073897096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75391-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-997-8000
Provider Business Mailing Address Fax Number:
972-234-2987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6204 BALCONES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78731-4214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-427-9400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP120962 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: AP120962 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 343950701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01868122 . This is a "RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com