1265679625 NPI number — DIANA EMILIA CARUBBA M.D.

Table of content: DIANA EMILIA CARUBBA M.D. (NPI 1265679625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265679625 NPI number — DIANA EMILIA CARUBBA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARUBBA
Provider First Name:
DIANA
Provider Middle Name:
EMILIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANCHEZ
Provider Other First Name:
DIANA
Provider Other Middle Name:
EMILIA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265679625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 UPTOWN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78520-7559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-621-4946
Provider Business Mailing Address Fax Number:
956-621-4950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 UPTOWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-621-4946
Provider Business Practice Location Address Fax Number:
956-621-4950
Provider Enumeration Date:
01/07/2009

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: 207R00000X , with the licence number:  N7339 , 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)

  • Identifier: 217752903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 320770601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DU3702 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".