1588757322 NPI number — SERGIO EDGARDO ABRIOLA MD FACC RCS

Table of content: SERGIO EDGARDO ABRIOLA MD FACC RCS (NPI 1588757322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588757322 NPI number — SERGIO EDGARDO ABRIOLA MD FACC RCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRIOLA
Provider First Name:
SERGIO
Provider Middle Name:
EDGARDO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD FACC RCS
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:
1588757322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
724 LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88435-2559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-472-4311
Provider Business Mailing Address Fax Number:
575-472-4313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
724 LAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88435-2559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-472-4311
Provider Business Practice Location Address Fax Number:
575-472-4313
Provider Enumeration Date:
10/02/2006

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: 207R00000X , with the licence number:  20020002 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 78150728 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009A32 . This is a "BCBS OF NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 10003253 . This is a "LOVELACE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26630 . This is a "LOVELACE SALUD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110248296 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201037659 . This is a "PRESBYTERIAN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PROVP11053 . This is a "MOLINA" identifier . This identifiers is of the category "OTHER".




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