1316309487 NPI number — VICTOR RIZAL ALTAVAS ARCEGA M.D.

Table of content: VICTOR RIZAL ALTAVAS ARCEGA M.D. (NPI 1316309487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316309487 NPI number — VICTOR RIZAL ALTAVAS ARCEGA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARCEGA
Provider First Name:
VICTOR RIZAL
Provider Middle Name:
ALTAVAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARCEGA
Provider Other First Name:
VICTOR
Provider Other Middle Name:
ALTAVAS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1316309487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 MEDICAL PARK STE 404
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-6392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-243-2964
Provider Business Mailing Address Fax Number:
304-243-6306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 MEDICAL PARK STE 404
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-6392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-243-2984
Provider Business Practice Location Address Fax Number:
304-243-6306
Provider Enumeration Date:
03/28/2016

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: 207RI0200X , with the licence number:  30362 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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