1710166426 NPI number — VIRGINIE MARIA VAN DRIEL CPC, LCADC

Table of content: VIRGINIE MARIA VAN DRIEL CPC, LCADC (NPI 1710166426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710166426 NPI number — VIRGINIE MARIA VAN DRIEL CPC, LCADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN DRIEL
Provider First Name:
VIRGINIE
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPC, LCADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN DRIEL
Provider Other First Name:
VIRGINIE
Provider Other Middle Name:
MARIA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710166426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8112 PEBBLESHIRE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-1370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-580-7744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8112 PEBBLESHIRE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89117-1370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-580-7744
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2007

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 , with the licence number:  4348 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: CP0236 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 6462286-6004 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1710166426 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".