1992820229 NPI number — MS. HILDA ELIZABETH HENRIQUEZ MFC 48258

Table of content: MS. HILDA ELIZABETH HENRIQUEZ MFC 48258 (NPI 1992820229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992820229 NPI number — MS. HILDA ELIZABETH HENRIQUEZ MFC 48258

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRIQUEZ
Provider First Name:
HILDA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFC 48258
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENRIQUEZ
Provider Other First Name:
HILDA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFC 48258
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1992820229
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20463
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90801-3463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-787-1178
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 E SAN ANTONIO DR
Provider Second Line Business Practice Location Address:
#2
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807-2221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-787-1178
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2007

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: 106H00000X , with the licence number:  MFC 48258 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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