1326235359 NPI number — DR. LOUISEA MARIE RAYMUN BONOAN DEOMAMPO M.D.

Table of content: AISHA BROWN (NPI 1518463496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326235359 NPI number — DR. LOUISEA MARIE RAYMUN BONOAN DEOMAMPO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEOMAMPO
Provider First Name:
LOUISEA MARIE RAYMUN
Provider Middle Name:
BONOAN
Provider Name Prefix Text:
DR.
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:
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:
1326235359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIVERSITY OF TEXAS MEDICAL BRANCH- RADIOLOGY
Provider Second Line Business Mailing Address:
301 UNIVERSITY BOULEVARD ROUTE 0709
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77555-0709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-772-2496
Provider Business Mailing Address Fax Number:
409-747-2825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY OF TEXAS MEDICAL BRANCH- RADIOLOGY
Provider Second Line Business Practice Location Address:
301 UNIVERSITY BOULEVARD ROUTE 0709
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77555-0709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-772-2496
Provider Business Practice Location Address Fax Number:
409-747-2825
Provider Enumeration Date:
10/03/2007

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: 2085B0100X , with the licence number:  TP10026846 , 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)





Copyright © 2007-2025 www.npivalidator.com