1003303470 NPI number — MS. ALICE KATEREGGA MD

Table of content: MS. ALICE KATEREGGA MD (NPI 1003303470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003303470 NPI number — MS. ALICE KATEREGGA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATEREGGA
Provider First Name:
ALICE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KATEREGGA
Provider Other First Name:
ALICE
Provider Other Middle Name:
MARY NANTABA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003303470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/28/2018
NPI Reactivation Date:
04/10/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3290 NW 9TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33127-3332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-747-7233
Provider Business Mailing Address Fax Number:
305-585-6043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 NW 12TH AVENUE JACKSON MEMORIAL HOSPITAL,
Provider Second Line Business Practice Location Address:
SURGICAL TRAINING OFFICE - HOLTZ BUILDING, ET 2169
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-585-1280
Provider Business Practice Location Address Fax Number:
305-585-6043
Provider Enumeration Date:
04/20/2018

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: 390200000X , with the licence number:  27733 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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