1255580957 NPI number — DR. GABRIELA MERCEDES REINHOLTZ DDS

Table of content: DR. GABRIELA MERCEDES REINHOLTZ DDS (NPI 1255580957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255580957 NPI number — DR. GABRIELA MERCEDES REINHOLTZ DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REINHOLTZ
Provider First Name:
GABRIELA
Provider Middle Name:
MERCEDES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SARDON
Provider Other First Name:
GABRIELA
Provider Other Middle Name:
MERCEDES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255580957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12035 BAMMEL NORTH HOUSTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77066-4703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-286-1014
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12035 BAMMEL NORTH HOUSTON RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77066-4703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-286-1014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2008

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: 122300000X , with the licence number:  24823 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 019.027621 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DN013802 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 212877902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".