1386881233 NPI number — DR. FABIO DURZZO DDS

Table of content: (NPI 1386881233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386881233 NPI number — DR. FABIO DURZZO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. FABIO DURZZO DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1386881233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
453 SERG LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78516-7285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-325-9795
Provider Business Mailing Address Fax Number:
956-783-5162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
192 ARTURO PLAZA COAHUILA
Provider Second Line Business Practice Location Address:
SUITE 1-B SECOND FLOOR
Provider Business Practice Location Address City Name:
PROGRESO
Provider Business Practice Location Address State Name:
TAMAULIPAS
Provider Business Practice Location Address Postal Code:
88810
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
956-325-9795
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRUZ
Authorized Official First Name:
BEATRIZ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-325-9795

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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