1528423043 NPI number — MRS. NATALIA K PAK PA

Table of content: MRS. NATALIA K PAK PA (NPI 1528423043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528423043 NPI number — MRS. NATALIA K PAK PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAK
Provider First Name:
NATALIA
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1528423043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 N LAMAR BLVD STE 200A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78753-5976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-387-8208
Provider Business Mailing Address Fax Number:
512-782-9316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4940 W UNIVERSITY DR STE 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75078-9914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-752-7111
Provider Business Practice Location Address Fax Number:
512-782-9316
Provider Enumeration Date:
12/28/2015

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: 363A00000X , with the licence number:  PA11730 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 019416 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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