1982858064 NPI number — DR. EVALINA WILLIAMS BESTMAN PH.D.

Table of content: DR. EVALINA WILLIAMS BESTMAN PH.D. (NPI 1982858064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982858064 NPI number — DR. EVALINA WILLIAMS BESTMAN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BESTMAN
Provider First Name:
EVALINA
Provider Middle Name:
WILLIAMS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1982858064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1065 NE 125TH ST
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
NORTH MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33161-5821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-895-4220
Provider Business Mailing Address Fax Number:
305-895-4168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1065 NE 125TH ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
NORTH MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33161-5821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-895-4220
Provider Business Practice Location Address Fax Number:
305-895-4168
Provider Enumeration Date:
11/16/2008

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: 103TC0700X , with the licence number:  PY2724 , 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: 101284500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com