1821372137 NPI number — JENNIFER M AMARAL MD PA

Table of content: (NPI 1821372137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821372137 NPI number — JENNIFER M AMARAL MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNIFER M AMARAL MD PA
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:
JENNIFER M AMARAL MD PA
Provider Other Organization Name Type Code:
3
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:
1821372137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 61160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78466-1160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-442-2442
Provider Business Mailing Address Fax Number:
361-857-0572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5920 SARATOGA BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78414-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-442-2442
Provider Business Practice Location Address Fax Number:
361-356-6101
Provider Enumeration Date:
10/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
AMARAL RAMOS
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
361-442-2442

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 375928401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 597380 . This is a "PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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