1447211123 NPI number — MARIA ROLIZA MUYOT M.D.

Table of content: MARIA ROLIZA MUYOT M.D. (NPI 1447211123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447211123 NPI number — MARIA ROLIZA MUYOT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUYOT
Provider First Name:
MARIA
Provider Middle Name:
ROLIZA
Provider Name Prefix Text:
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:
1447211123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12281 BLUEBIRD CANYON PL
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:
89138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-396-9858
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7180 CASCADE VALLEY CT
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-0449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-641-2150
Provider Business Practice Location Address Fax Number:
702-228-1043
Provider Enumeration Date:
03/31/2006

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: 208000000X , with the licence number:  9822 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002018634 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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