1629830997 NPI number — KATRIANNA DOLORES PRANGA PHARMD

Table of content: KATRIANNA DOLORES PRANGA PHARMD (NPI 1629830997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629830997 NPI number — KATRIANNA DOLORES PRANGA PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRANGA
Provider First Name:
KATRIANNA
Provider Middle Name:
DOLORES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SALTARELLI
Provider Other First Name:
KATRIANNA
Provider Other Middle Name:
DOLORES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629830997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 DAVID L GOLDFEIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLOMAN AFB
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88330-8273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-572-0590
Provider Business Mailing Address Fax Number:
575-572-5781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 DAVID L GOLDFEIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLOMAN AFB
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88330-8273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-572-0590
Provider Business Practice Location Address Fax Number:
575-572-5781
Provider Enumeration Date:
01/23/2024

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: 1835P0018X , with the licence number:  E-100787 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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