1073595914 NPI number — BEATRIZ EUGENIA MEZA-VALENCIA MD

Table of content: BEATRIZ EUGENIA MEZA-VALENCIA MD (NPI 1073595914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073595914 NPI number — BEATRIZ EUGENIA MEZA-VALENCIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEZA-VALENCIA
Provider First Name:
BEATRIZ
Provider Middle Name:
EUGENIA
Provider Name Prefix Text:
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:
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:
1073595914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 GENERAL HOSPITAL BOX 712
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
011821192820847
Provider Business Mailing Address Fax Number:
01182279173094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 GENERAL HOSPITAL
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PEDIATRICS
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
01182279178072
Provider Business Practice Location Address Fax Number:
01182279173094
Provider Enumeration Date:
11/16/2005

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: 208000000X , with the licence number:  MD11838 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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