1255318531 NPI number — MR. RANDY T VIRAY RN

Table of content: MR. RANDY T VIRAY RN (NPI 1255318531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255318531 NPI number — MR. RANDY T VIRAY RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIRAY
Provider First Name:
RANDY
Provider Middle Name:
T
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
M

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:
1255318531
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:
1 JARRETT WHITE RD
Provider Second Line Business Mailing Address:
TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS
Provider Business Mailing Address City Name:
TAMC
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96859-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-433-2460
Provider Business Mailing Address Fax Number:
808-433-1558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 JARRETT WHITE RD
Provider Second Line Business Practice Location Address:
TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS
Provider Business Practice Location Address City Name:
TAMC
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96859-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-2460
Provider Business Practice Location Address Fax Number:
808-433-1558
Provider Enumeration Date:
12/28/2005

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: 163W00000X , with the licence number:  RN00147624 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RN00147624 . This is a "NURSING LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".