1750561833 NPI number — PASSION MEDICAL ASSOCIATES INC

Table of content: JANELLE IRIS MATIAS TANGHAL (NPI 1992478960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750561833 NPI number — PASSION MEDICAL ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PASSION MEDICAL ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1750561833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 371708
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89137-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-798-1233
Provider Business Mailing Address Fax Number:
702-531-1233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4240 SIMMONS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89032-0766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-798-1233
Provider Business Practice Location Address Fax Number:
702-531-1233
Provider Enumeration Date:
11/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ASAFO-ADJEI
Authorized Official First Name:
PETER
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
702-868-7777

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  12241 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com