1669604989 NPI number — ANTONIETTE JOY CADIZ FAILAGUTAN

Table of content: ANTONIETTE JOY CADIZ FAILAGUTAN (NPI 1669604989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669604989 NPI number — ANTONIETTE JOY CADIZ FAILAGUTAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAILAGUTAN
Provider First Name:
ANTONIETTE JOY
Provider Middle Name:
CADIZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1669604989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2151 LINGLESTOWN RD
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17110-9499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-829-1468
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2151 LINGLESTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-9499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-829-1468
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2009

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: 225100000X , with the licence number:  PT018147 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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