1407980964 NPI number — MISS GRACIELA ALEJANDRA LOPEZ M.A.

Table of content: MISS GRACIELA ALEJANDRA LOPEZ M.A. (NPI 1407980964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407980964 NPI number — MISS GRACIELA ALEJANDRA LOPEZ M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
GRACIELA
Provider Middle Name:
ALEJANDRA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.A.
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:
1407980964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 AVENUE 64
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91105-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-254-2274
Provider Business Mailing Address Fax Number:
323-254-5022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
940 AVENUE 64
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-2711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-254-2274
Provider Business Practice Location Address Fax Number:
323-254-5022
Provider Enumeration Date:
03/15/2007

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: 225400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com