1184865107 NPI number — SHIRLINA LIA ALCALA N.P.

Table of content: SHIRLINA LIA ALCALA N.P. (NPI 1184865107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184865107 NPI number — SHIRLINA LIA ALCALA N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALCALA
Provider First Name:
SHIRLINA
Provider Middle Name:
LIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILL
Provider Other First Name:
SHIRLINA
Provider Other Middle Name:
LIA
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:
1184865107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 593
Provider Second Line Business Mailing Address:
200 POCAHONTAS TRAIL
Provider Business Mailing Address City Name:
WHITE SULPHUR SPRINGS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24986-0593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-536-5030
Provider Business Mailing Address Fax Number:
304-536-5031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9870 GATEWAY BLVD N
Provider Second Line Business Practice Location Address:
SUITE B7
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79924-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-751-5245
Provider Business Practice Location Address Fax Number:
915-751-5255
Provider Enumeration Date:
03/20/2009

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: 363LF0000X , with the licence number:  AP117861 , 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)

  • Identifier: 2898397-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com