1790404440 NPI number — ALICIA DENISE CARDOZA AAS

Table of content: ALICIA DENISE CARDOZA AAS (NPI 1790404440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790404440 NPI number — ALICIA DENISE CARDOZA AAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDOZA
Provider First Name:
ALICIA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AAS
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:
1790404440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1923 SULPHUR SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37813-5654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-317-9344
Provider Business Mailing Address Fax Number:
423-714-2355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2240 SUTHERLAND AVE STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-934-6150
Provider Business Practice Location Address Fax Number:
865-342-0100
Provider Enumeration Date:
08/25/2022

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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