1104264373 NPI number — MRS. MA ANA LAGON PADURA R.P.T.

Table of content: MRS. MA ANA LAGON PADURA R.P.T. (NPI 1104264373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104264373 NPI number — MRS. MA ANA LAGON PADURA R.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADURA
Provider First Name:
MA ANA
Provider Middle Name:
LAGON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAGON
Provider Other First Name:
MA ANA
Provider Other Middle Name:
TAPIZ
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104264373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4021 N PINE ISLAND RD
Provider Second Line Business Mailing Address:
APARTMENT 404
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33351-6520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-470-5818
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4021 N PINE ISLAND RD
Provider Second Line Business Practice Location Address:
APARTMENT 404
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33351-6520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-470-5818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2013

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: 225100000X , with the licence number:  1227658 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com