1215063227 NPI number — MRS. VIKKI LARAE PRESAS WHNP

Table of content: MRS. VIKKI LARAE PRESAS WHNP (NPI 1215063227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215063227 NPI number — MRS. VIKKI LARAE PRESAS WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRESAS
Provider First Name:
VIKKI
Provider Middle Name:
LARAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRESAS
Provider Other First Name:
VIKKI
Provider Other Middle Name:
LARAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RNC, WHNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215063227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 E PRICE RD
Provider Second Line Business Mailing Address:
BLDG A
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78521-3531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-350-8788
Provider Business Mailing Address Fax Number:
956-350-0009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4970 NORTH EXPRESSWAY 77
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-350-8788
Provider Business Practice Location Address Fax Number:
956-350-0009
Provider Enumeration Date:
02/26/2007

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: 163WW0101X , with the licence number:  163WW0101X , 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)