1649410580 NPI number — CATHERINE RAHM COUDRAY LIC AP DILP. AC OMD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649410580 NPI number — CATHERINE RAHM COUDRAY LIC AP DILP. AC OMD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUDRAY
Provider First Name:
CATHERINE
Provider Middle Name:
RAHM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LIC AP DILP. AC OMD.
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:
1649410580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1716 EAST IRLO BRONSON MEM HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST CLOUD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-303-5240
Provider Business Mailing Address Fax Number:
321-244-0453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1716 EAST IRLO BRONSON MEM HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST CLOUD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-303-5240
Provider Business Practice Location Address Fax Number:
321-244-0453
Provider Enumeration Date:
03/05/2009

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: 171100000X , with the licence number:  AP1399 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AP1399 . This is a "LIC NUMBER FL." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 101770400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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