1265502231 NPI number — DR. BIENVENIDO TECSON LAMORENA MD

Table of content: THERESA TOOMEY RITTMANN (NPI 1326748211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265502231 NPI number — DR. BIENVENIDO TECSON LAMORENA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMORENA
Provider First Name:
BIENVENIDO
Provider Middle Name:
TECSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1265502231
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:
9336 NATCHEZ AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORTON GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60053-1445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-777-9400
Provider Business Mailing Address Fax Number:
773-777-6917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5356 W DIVERSEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60639-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-777-9400
Provider Business Practice Location Address Fax Number:
773-777-6917
Provider Enumeration Date:
11/08/2006

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: 207K00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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