1437136439 NPI number — MRS. JACQUELINE E BVLGARI PA-C

Table of content: MRS. JACQUELINE E BVLGARI PA-C (NPI 1437136439)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437136439 NPI number — MRS. JACQUELINE E BVLGARI PA-C

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
BVLGARI

Provider First Name:
JACQUELINE

Provider Middle Name:
E

Provider Name Prefix Text:
MRS.

Provider Name Suffix Text:

Provider Credential Text:
PA-C

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
KING

Provider Other First Name:
JACQUELINE

Provider Other Middle Name:
E

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:
PA-C

Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437136439

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
11/09/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2931 HARNEY PATH RM 247

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
JBSA FT SAM HOUSTON

Provider Business Mailing Address State Name:
TX

Provider Business Mailing Address Postal Code:
78234-7674

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
808-282-2080

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 3RD ST W BLDG 1040

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
JBSA RANDOLPH

Provider Business Practice Location Address State Name:
TX

Provider Business Practice Location Address Postal Code:
78150-4800

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
808-282-2080

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
12/30/2005

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: 363AM0700X , with the licence number: 1045517 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .