1649483967 NPI number — INFANT JESUS PEDIATRICS PLC

Table of content: (NPI 1649483967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649483967 NPI number — INFANT JESUS PEDIATRICS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFANT JESUS PEDIATRICS PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1649483967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 N 6TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPEWELL
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23860-2618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-458-1430
Provider Business Mailing Address Fax Number:
804-458-8857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 NORTH 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPEWELL
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23860-2618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-458-1430
Provider Business Practice Location Address Fax Number:
804-458-8857
Provider Enumeration Date:
05/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GONZALES
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
804-458-1430

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  0101026123 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1891720074 . This is a "DR PATRICIA GONZALES NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1538131625 . This is a "DR HERMES DIZON NPI" identifier . This identifiers is of the category "OTHER".