1861882789 NPI number — DR. MA GENEFE LAGUNA HUTCHINSON DPT

Table of content: DR. MA GENEFE LAGUNA HUTCHINSON DPT (NPI 1861882789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861882789 NPI number — DR. MA GENEFE LAGUNA HUTCHINSON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTCHINSON
Provider First Name:
MA GENEFE
Provider Middle Name:
LAGUNA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUTCHINSON
Provider Other First Name:
GENEFE
Provider Other Middle Name:
LAGUNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1861882789
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1104 RUSH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CELEBRATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34747-4874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-298-5696
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1104 RUSH CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CELEBRATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34747-4874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-298-5696
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2015

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:  PT11594 , 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)





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