1841316502 NPI number — MS. JANET M KINNUNEN OTR CHT

Table of content: MS. JANET M KINNUNEN OTR CHT (NPI 1841316502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841316502 NPI number — MS. JANET M KINNUNEN OTR CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINNUNEN
Provider First Name:
JANET
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOPEZ
Provider Other First Name:
JANET
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR CHT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841316502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7400 MERTON MINTER ST
Provider Second Line Business Mailing Address:
FO13
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-4404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-617-5300
Provider Business Mailing Address Fax Number:
210-617-5391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7400 MERTON MINTER ST
Provider Second Line Business Practice Location Address:
FO13
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-617-5300
Provider Business Practice Location Address Fax Number:
210-617-5391
Provider Enumeration Date:
03/22/2007

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: 225X00000X , with the licence number:  000802 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1252510001 . This is a "MEDICARE NSC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 81793T . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P98448 . This is a "UPIN NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100802 . This is a "OT LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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