1972684611 NPI number — JOSEPHINE GALLARDO REINOSO RPT

Table of content: JOSEPHINE GALLARDO REINOSO RPT (NPI 1972684611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972684611 NPI number — JOSEPHINE GALLARDO REINOSO RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REINOSO
Provider First Name:
JOSEPHINE
Provider Middle Name:
GALLARDO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GALLARDO
Provider Other First Name:
JOSEPHINE
Provider Other Middle Name:
ABAYON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972684611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99671
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-873-6220
Provider Business Mailing Address Fax Number:
313-873-6788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9427 CONANT ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HAMTRAMCK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-873-6220
Provider Business Practice Location Address Fax Number:
313-873-6788
Provider Enumeration Date:
10/18/2006

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: 225100000X , with the licence number:  5501004272 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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