1861413445 NPI number — TRACEY E GIAMBRONE DPM

Table of content: TRACEY E GIAMBRONE DPM (NPI 1861413445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861413445 NPI number — TRACEY E GIAMBRONE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIAMBRONE
Provider First Name:
TRACEY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1861413445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8173
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89507-8173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-786-5333
Provider Business Mailing Address Fax Number:
775-786-5333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 KAUAI CT
Provider Second Line Business Practice Location Address:
SUITE #103
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-4850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-786-5333
Provider Business Practice Location Address Fax Number:
775-786-5333
Provider Enumeration Date:
07/21/2006

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: 213ES0103X , with the licence number:  2060 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002116016 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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