1710223169 NPI number — MARITZA AMINTA HOGAN PH.D.

Table of content: MARITZA AMINTA HOGAN PH.D. (NPI 1710223169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710223169 NPI number — MARITZA AMINTA HOGAN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOGAN
Provider First Name:
MARITZA
Provider Middle Name:
AMINTA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1710223169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 N HARVIN ST FL 6
Provider Second Line Business Mailing Address:
SC DEPARTMENT OF JUVENILE JUSTICE
Provider Business Mailing Address City Name:
SUMTER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29150-4956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-778-2368
Provider Business Mailing Address Fax Number:
803-775-2377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 N HARVIN ST FL 6
Provider Second Line Business Practice Location Address:
SC DEPARTMENT OF JUVENILE JUSTICE
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-4956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-778-2368
Provider Business Practice Location Address Fax Number:
803-775-2377
Provider Enumeration Date:
12/12/2012

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: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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