1285726489 NPI number — DR. MARIA CELMIRA MANCEBO COLTEY PH.D.

Table of content: DR. MARIA CELMIRA MANCEBO COLTEY PH.D. (NPI 1285726489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285726489 NPI number — DR. MARIA CELMIRA MANCEBO COLTEY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLTEY
Provider First Name:
MARIA
Provider Middle Name:
CELMIRA MANCEBO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANCEBO
Provider Other First Name:
MARIA
Provider Other Middle Name:
CELMIRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285726489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 BLACKSTONE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02906-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-455-6216
Provider Business Mailing Address Fax Number:
401-455-6442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 BLACKSTONE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02906-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-455-6216
Provider Business Practice Location Address Fax Number:
401-455-6442
Provider Enumeration Date:
09/28/2006

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: 103TC0700X , with the licence number:  PS00867 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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