1003801572 NPI number — MR. JOHN (JACK) SILVIO VOLPATO JR. RPH,PHC

Table of content: ROSHONDA STRECK (NPI 1801466966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003801572 NPI number — MR. JOHN (JACK) SILVIO VOLPATO JR. RPH,PHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOLPATO
Provider First Name:
JOHN (JACK)
Provider Middle Name:
SILVIO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
RPH,PHC
Provider Gender Code:
M

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:
1003801572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1526 MUSCATEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88220-9201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-885-3716
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2402 W PIERCE ST
Provider Second Line Business Practice Location Address:
1-A
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88220-3537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-887-6611
Provider Business Practice Location Address Fax Number:
505-887-0782
Provider Enumeration Date:
09/12/2005

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: 183500000X , with the licence number:  4982 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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