1902960123 NPI number — DR. ELIZABETH BABASA EBILANE MD

Table of content: DR. NILESH C KANSANGRA D.M.D. (NPI 1407974694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902960123 NPI number — DR. ELIZABETH BABASA EBILANE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBILANE
Provider First Name:
ELIZABETH
Provider Middle Name:
BABASA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1902960123
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:
PO BOX 186
Provider Second Line Business Mailing Address:
SUBIC BAY FREEPORT ZONE
Provider Business Mailing Address City Name:
OLONGAPO CITY
Provider Business Mailing Address State Name:
ZAMBALES
Provider Business Mailing Address Postal Code:
2000
Provider Business Mailing Address Country Code:
PH
Provider Business Mailing Address Telephone Number:
63472237664
Provider Business Mailing Address Fax Number:
63472325245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 NATIONAL HI WAY
Provider Second Line Business Practice Location Address:
BO BARRETTO
Provider Business Practice Location Address City Name:
OLONGAPO CITY
Provider Business Practice Location Address State Name:
ZAMBALES
Provider Business Practice Location Address Postal Code:
2200
Provider Business Practice Location Address Country Code:
PH
Provider Business Practice Location Address Telephone Number:
63472237664
Provider Business Practice Location Address Fax Number:
63472325245
Provider Enumeration Date:
12/21/2006

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: 207Q00000X , with the licence number:  68080 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHL002415 . This is a "TRICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: PHL009321 . This is a "TRICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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