1801870464 NPI number — MS. MARITESS GALUEZ DE JESUS PT

Table of content: MS. MARITESS GALUEZ DE JESUS PT (NPI 1801870464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801870464 NPI number — MS. MARITESS GALUEZ DE JESUS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE JESUS
Provider First Name:
MARITESS
Provider Middle Name:
GALUEZ
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1801870464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 CEDAR CREEK CT
Provider Second Line Business Mailing Address:
APART 227
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95355-5241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-524-2833
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 EASTWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANTECA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95336-3167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-239-1222
Provider Business Practice Location Address Fax Number:
209-825-3052
Provider Enumeration Date:
12/06/2005

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 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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