1467638833 NPI number — MRS. BRETHA NWAMAKA KEMAKOLAM N/A

Table of content: NICHOLAS MICHAEL POLLOCK (NPI 1982109567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467638833 NPI number — MRS. BRETHA NWAMAKA KEMAKOLAM N/A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEMAKOLAM
Provider First Name:
BRETHA
Provider Middle Name:
NWAMAKA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
N/A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
N/A
Provider Other First Name:
N/A
Provider Other Middle Name:
N/A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N/A
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1467638833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2122 REDCLIFF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOURI CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77489-5023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-878-2895
Provider Business Mailing Address Fax Number:
281-261-1273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2122 REDCLIFF DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOURI CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77489-5023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-878-2895
Provider Business Practice Location Address Fax Number:
281-261-1273
Provider Enumeration Date:
01/16/2008

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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