1588757322 NPI number — SERGIO EDGARDO ABRIOLA MD FACC RCS

Table of content: HANNAH J PROBST (NPI 1457031460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588757322 NPI number — SERGIO EDGARDO ABRIOLA MD FACC RCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRIOLA
Provider First Name:
SERGIO
Provider Middle Name:
EDGARDO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD FACC RCS
Provider Gender Code:
M

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:
1588757322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
724 LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88435-2559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-472-4311
Provider Business Mailing Address Fax Number:
575-472-4313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
724 LAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88435-2559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-472-4311
Provider Business Practice Location Address Fax Number:
575-472-4313
Provider Enumeration Date:
10/02/2006

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: 207R00000X , with the licence number:  20020002 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 78150728 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009A32 . This is a "BCBS OF NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 10003253 . This is a "LOVELACE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26630 . This is a "LOVELACE SALUD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110248296 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201037659 . This is a "PRESBYTERIAN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PROVP11053 . This is a "MOLINA" identifier . This identifiers is of the category "OTHER".




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