1285823575 NPI number — DR. ZENAIDA MIRELA HOMENTCOVSCHI M.D.

Table of content: DR. ZENAIDA MIRELA HOMENTCOVSCHI M.D. (NPI 1285823575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285823575 NPI number — DR. ZENAIDA MIRELA HOMENTCOVSCHI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOMENTCOVSCHI
Provider First Name:
ZENAIDA
Provider Middle Name:
MIRELA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIACONU
Provider Other First Name:
ZENAIDA
Provider Other Middle Name:
MIRELA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285823575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 E MOUNT HOPE AVE
Provider Second Line Business Mailing Address:
WELL CHILD CLINIC
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48910-3207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-372-9175
Provider Business Mailing Address Fax Number:
517-372-9188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 E MOUNT HOPE AVE
Provider Second Line Business Practice Location Address:
WELL CHILD CLINIC
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48910-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-372-9175
Provider Business Practice Location Address Fax Number:
517-372-9188
Provider Enumeration Date:
10/23/2007

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: 208000000X , with the licence number:  4301085884 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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