1447230578 NPI number — MS. MARIA ELOISA MENDOZA AVEO P.T.

Table of content: MS. MARIA ELOISA MENDOZA AVEO P.T. (NPI 1447230578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447230578 NPI number — MS. MARIA ELOISA MENDOZA AVEO P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVEO
Provider First Name:
MARIA ELOISA
Provider Middle Name:
MENDOZA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1447230578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4560 SE INTERNATIONAL WAY
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
MILWAUKIE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-206-5200
Provider Business Mailing Address Fax Number:
917-206-5203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 ATRIUM PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-257-4957
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2006

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: 225100000X , with the licence number:  32113 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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