1457645889 NPI number — MRS. TESSANDRA NOEL DE ALBERDI VISCO MS, CRC

Table of content: MRS. TESSANDRA NOEL DE ALBERDI VISCO MS, CRC (NPI 1457645889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457645889 NPI number — MRS. TESSANDRA NOEL DE ALBERDI VISCO MS, CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE ALBERDI VISCO
Provider First Name:
TESSANDRA
Provider Middle Name:
NOEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE ALBERDI PEARSON
Provider Other First Name:
TESSANDRA
Provider Other Middle Name:
NOEL
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, CRC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457645889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 VESPER LN UNIT L1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NANTUCKET
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02554-4394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-228-2689
Provider Business Mailing Address Fax Number:
508-228-3616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 VESPER LN UNIT L1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NANTUCKET
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02554-4394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-228-2689
Provider Business Practice Location Address Fax Number:
508-228-3616
Provider Enumeration Date:
06/02/2011

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: 101YM0800X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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