1922548668 NPI number — DIANA JHAMAE LABRADOR SIMON PTA

Table of content: DIANA JHAMAE LABRADOR SIMON PTA (NPI 1922548668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922548668 NPI number — DIANA JHAMAE LABRADOR SIMON PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
DIANA JHAMAE
Provider Middle Name:
LABRADOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PTA
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:
1922548668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94-099 WAIPAHU ST APT A212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAIPAHU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96797-1712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-600-9147
Provider Business Mailing Address Fax Number:
800-942-7053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94-216 FARRINGTON HWY BOX202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-600-9147
Provider Business Practice Location Address Fax Number:
800-942-7053
Provider Enumeration Date:
02/28/2017

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: 225200000X , with the licence number:  PTA-346 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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