1215905369 NPI number — JOVEN MARQUEZ ZANO IDC

Table of content: JOVEN MARQUEZ ZANO IDC (NPI 1215905369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215905369 NPI number — JOVEN MARQUEZ ZANO IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZANO
Provider First Name:
JOVEN
Provider Middle Name:
MARQUEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IDC
Provider Gender Code:
M

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:
1215905369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6431 SEWELLS POINT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23513-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-343-2234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 561 BOX 1001
Provider Second Line Business Practice Location Address:
FPO AP 96310
Provider Business Practice Location Address City Name:
IWAKUNI
Provider Business Practice Location Address State Name:
YAMAGUCHI
Provider Business Practice Location Address Postal Code:
96310
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
81827214171
Provider Business Practice Location Address Fax Number:
2535122
Provider Enumeration Date:
03/14/2006

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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