1477762946 NPI number — M &J ENTERPRISES OF NC,INC.

Table of content: DIANA CRISTINA MOSCOSO MA, NCC, LPCA (NPI 1770139842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477762946 NPI number — M &J ENTERPRISES OF NC,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M &J ENTERPRISES OF NC,INC.
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:
1477762946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19415
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28219-9415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-605-5142
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11036 PADDERBORN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28215-7394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-605-5142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARRETT
Authorized Official First Name:
MINDY
Authorized Official Middle Name:
TOMORROW
Authorized Official Title or Position:
OWNER DIRECTOR
Authorized Official Telephone Number:
704-605-5142

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6601385 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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