1063931020 NPI number — DR. PETER ALLAN AVILA QUITASOL M.D.

Table of content: DR. PETER ALLAN AVILA QUITASOL M.D. (NPI 1063931020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063931020 NPI number — DR. PETER ALLAN AVILA QUITASOL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUITASOL
Provider First Name:
PETER ALLAN
Provider Middle Name:
AVILA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1063931020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 GENERAL LUNA ST NOTRE DAME DE CHARTRES HOSPITAL
Provider Second Line Business Mailing Address:
RM 208 PUEBLO DE MARIA BLDG
Provider Business Mailing Address City Name:
BAGUIO CITY
Provider Business Mailing Address State Name:
BENGUET
Provider Business Mailing Address Postal Code:
02600
Provider Business Mailing Address Country Code:
PH
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 GEN. LUNA ST. NOTRE DAME DE CHARTRES HOSPITAL
Provider Second Line Business Practice Location Address:
RM 208 PUEBLO DE MARIA BLDG
Provider Business Practice Location Address City Name:
BAGUIO CITY
Provider Business Practice Location Address State Name:
BENGUET
Provider Business Practice Location Address Postal Code:
02600
Provider Business Practice Location Address Country Code:
PH
Provider Business Practice Location Address Telephone Number:
74-424-3361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2017

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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