1033454715 NPI number — PARABASE GENOMICS INC

Table of content: DR. DANIEL ALBERTO OPORTO PSY.D. (NPI 1407644735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033454715 NPI number — PARABASE GENOMICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARABASE GENOMICS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1033454715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 DRYDOCK AVE, 2ND FLOOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
857-288-0838
Provider Business Mailing Address Fax Number:
866-604-9369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 DRYDOCK AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02210-2377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
857-288-0838
Provider Business Practice Location Address Fax Number:
866-604-9369
Provider Enumeration Date:
12/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BETHLENDY
Authorized Official First Name:
GABOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF COMMERCIAL OFFICER
Authorized Official Telephone Number:
857-288-0838

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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