1538395934 NPI number — MISS TERESA GAINES RD,LD

Table of content: MISS TERESA GAINES RD,LD (NPI 1538395934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538395934 NPI number — MISS TERESA GAINES RD,LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAINES
Provider First Name:
TERESA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RD,LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAINES
Provider Other First Name:
TERESA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538395934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3219 SABRINA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPPERAS COVE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76522-3715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-289-0760
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 JARRETT WHITE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRIPLER ARMY MEDICAL CENTER
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96859-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-2387
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2009

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: 133V00000X , with the licence number:  DT80776 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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