1194952408 NPI number — ROQUE MIRAMONTES PA, MPH

Table of content: ROQUE MIRAMONTES PA, MPH (NPI 1194952408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194952408 NPI number — ROQUE MIRAMONTES PA, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRAMONTES
Provider First Name:
ROQUE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA, MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIRAMONTES
Provider Other First Name:
ROQUE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1194952408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 CLIFTON RD NE
Provider Second Line Business Mailing Address:
MS: E-10
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30329-4018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-639-6306
Provider Business Mailing Address Fax Number:
404-929-2854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 CLIFTON RD NE
Provider Second Line Business Practice Location Address:
MS: E-10
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30329-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-639-6306
Provider Business Practice Location Address Fax Number:
404-929-2854
Provider Enumeration Date:
06/12/2009

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: 363A00000X , with the licence number:  005548 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: PA16051 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA10004457 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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