1790125730 NPI number — JOSEPH REGANALBERTO GOUVEIA CMHC

Table of content: JOSEPH REGANALBERTO GOUVEIA CMHC (NPI 1790125730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790125730 NPI number — JOSEPH REGANALBERTO GOUVEIA CMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOUVEIA
Provider First Name:
JOSEPH
Provider Middle Name:
REGANALBERTO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CMHC
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:
1790125730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 S FASHION BLVD STE 211
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84107-5435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-520-7938
Provider Business Mailing Address Fax Number:
800-528-1208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2156 W 6000 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84067-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-520-7938
Provider Business Practice Location Address Fax Number:
800-528-1208
Provider Enumeration Date:
07/03/2013

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: 101YM0800X , with the licence number:  8598292-6009 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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