1083773287 NPI number — MRS. MAUREEN ONEAL POLIKOFF MSW

Table of content: MRS. MAUREEN ONEAL POLIKOFF MSW (NPI 1083773287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083773287 NPI number — MRS. MAUREEN ONEAL POLIKOFF MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLIKOFF
Provider First Name:
MAUREEN
Provider Middle Name:
ONEAL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

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:
1083773287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1519 PHOENIX AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87107-1059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-345-1262
Provider Business Mailing Address Fax Number:
505-345-1262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4233 MONTGOMERY BLVD NE
Provider Second Line Business Practice Location Address:
SUITE 200-W
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-6749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-321-8506
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2006

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: 1041C0700X , with the licence number:  I-3214 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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