1023380557 NPI number — BLANCA MATILDE BARRIOS DE REYES

Table of content: BLANCA MATILDE BARRIOS DE REYES (NPI 1023380557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023380557 NPI number — BLANCA MATILDE BARRIOS DE REYES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRIOS DE REYES
Provider First Name:
BLANCA
Provider Middle Name:
MATILDE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1023380557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16652 SW WARFIELD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANTOWN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34956-4407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-597-0578
Provider Business Mailing Address Fax Number:
772-597-0579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1631 LAKEFIELD NORTH CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-1066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-792-9319
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2012

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: 171M00000X , 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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