1457781981 NPI number — ACU-MED INTEGRATIVE MEDICINE LLC

Table of content: DR. LADY PAULA JOSE DEJESUS DPM (NPI 1558643221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457781981 NPI number — ACU-MED INTEGRATIVE MEDICINE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACU-MED INTEGRATIVE MEDICINE LLC
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:
6
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:
1457781981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 DOLPHIN DR STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUKESHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53186-1489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-832-8888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1428 E RACINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53186-6462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-832-8888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
REX
Authorized Official First Name:
XUEFEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
262-832-8888

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  713-055 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X , with the licence number: 491055 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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