1649200528 NPI number — DR. JAVIER ITURBE MD

Table of content: DR. JAVIER ITURBE MD (NPI 1649200528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649200528 NPI number — DR. JAVIER ITURBE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ITURBE
Provider First Name:
JAVIER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1649200528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2590 CAMINO ENTRADA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87507-4876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-946-3233
Provider Business Mailing Address Fax Number:
505-946-3234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2590 CAMINO ENTRADA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87507-4876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-946-3233
Provider Business Practice Location Address Fax Number:
505-946-3234
Provider Enumeration Date:
07/04/2006

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: 208000000X , with the licence number:  90-55 , 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: 37621 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PROVP13605 . This is a "MOLINA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10001170 . This is a "LOVELACE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2746097 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 46433 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: NM029F61 . This is a "BCBS NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 000810819410 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202010518 . This is a "PRESBYTERIAN HEALTH PLANS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com