1053459578 NPI number — MARIA ALELI TABIO ELLO M.D.

Table of content: MARIA ALELI TABIO ELLO M.D. (NPI 1053459578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053459578 NPI number — MARIA ALELI TABIO ELLO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLO
Provider First Name:
MARIA ALELI
Provider Middle Name:
TABIO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELLO
Provider Other First Name:
MARIA
Provider Other Middle Name:
TABIO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1053459578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3730 PLAZA WAY
Provider Second Line Business Mailing Address:
FLOOR 5
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99338-2718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-222-2240
Provider Business Mailing Address Fax Number:
509-222-2239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4309 W. 27TH AVE.
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-0128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-222-2240
Provider Business Practice Location Address Fax Number:
509-222-2239
Provider Enumeration Date:
02/05/2007

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: 207Q00000X , with the licence number:  MD00045901 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1053459578 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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