1780033936 NPI number — ANITA RIBEIRO-BLANCHARD P.A.

Table of content: (NPI 1780033936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780033936 NPI number — ANITA RIBEIRO-BLANCHARD P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANITA RIBEIRO-BLANCHARD P.A.
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:
1780033936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
524 VIA GENOVA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEERFIELD BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33442-8626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-501-8095
Provider Business Mailing Address Fax Number:
561-270-0811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 S DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 507
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33432-7452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-501-8095
Provider Business Practice Location Address Fax Number:
561-270-0811
Provider Enumeration Date:
06/08/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIBEIRO
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
561-501-8095

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH6591 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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