1760599773 NPI number — FRANCISCO JAVIER RIVERA-CARABALLO PT

Table of content: FRANCISCO JAVIER RIVERA-CARABALLO PT (NPI 1760599773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760599773 NPI number — FRANCISCO JAVIER RIVERA-CARABALLO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA-CARABALLO
Provider First Name:
FRANCISCO
Provider Middle Name:
JAVIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1760599773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 491
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59920-0491
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-471-8100
Provider Business Mailing Address Fax Number:
866-890-6494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 1ST AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901-4938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-471-8100
Provider Business Practice Location Address Fax Number:
866-890-6494
Provider Enumeration Date:
08/24/2006

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: 225100000X , with the licence number:  7699 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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