1689962565 NPI number — JAIME DURAND MASTERS

Table of content: JAIME DURAND MASTERS (NPI 1689962565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689962565 NPI number — JAIME DURAND MASTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURAND
Provider First Name:
JAIME
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASTERS
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:
1689962565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
136 LARCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOONSOCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02895-6712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-422-6093
Provider Business Mailing Address Fax Number:
401-226-9381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 LARCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-422-6093
Provider Business Practice Location Address Fax Number:
401-226-9381
Provider Enumeration Date:
07/13/2011

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MHC00615 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GH57134 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".