1417025016 NPI number — JACQUELINE S CARDER RD, LD

Table of content: JACQUELINE S CARDER RD, LD (NPI 1417025016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417025016 NPI number — JACQUELINE S CARDER RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDER
Provider First Name:
JACQUELINE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, LD
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:
1417025016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13214 LOMA VALLEJO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78233-2418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-429-3543
Provider Business Mailing Address Fax Number:
210-579-6489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13214 LOMA VALLEJO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78233-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-429-3543
Provider Business Practice Location Address Fax Number:
210-579-6489
Provider Enumeration Date:
12/01/2006

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: 133VN1005X , with the licence number:  DT81640 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133NN1002X , with the licence number: DT81640 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133VN1006X , with the licence number: DT81640 , 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)