1407532369 NPI number — JULIA MARIE MARANVILLE PSYCHOLOGY STUDENT

Table of content: JULIA MARIE MARANVILLE PSYCHOLOGY STUDENT (NPI 1407532369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407532369 NPI number — JULIA MARIE MARANVILLE PSYCHOLOGY STUDENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARANVILLE
Provider First Name:
JULIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYCHOLOGY STUDENT
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:
1407532369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6460 MEDICAL CENTER ST STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89148-2406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-888-1340
Provider Business Mailing Address Fax Number:
702-888-1342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6460 MEDICAL CENTER ST STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-888-1340
Provider Business Practice Location Address Fax Number:
702-888-1342
Provider Enumeration Date:
06/26/2023

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: 390200000X ; 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