1811017825 NPI number — ANGELICA JAVIER ABRENICA RPT

Table of content: ANGELICA JAVIER ABRENICA RPT (NPI 1811017825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811017825 NPI number — ANGELICA JAVIER ABRENICA RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRENICA
Provider First Name:
ANGELICA
Provider Middle Name:
JAVIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1811017825
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:
8233 EAGLES PARK DR N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33709-7008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-504-2269
Provider Business Mailing Address Fax Number:
727-544-2269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2007 DODGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33760-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-481-1694
Provider Business Practice Location Address Fax Number:
727-535-5856
Provider Enumeration Date:
03/31/2007

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:  PT8441 , 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)