1063686582 NPI number — MR. JOSE ROMMEL MONTANO RAYOS IDC

Table of content: MR. JOSE ROMMEL MONTANO RAYOS IDC (NPI 1063686582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063686582 NPI number — MR. JOSE ROMMEL MONTANO RAYOS IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAYOS
Provider First Name:
JOSE ROMMEL
Provider Middle Name:
MONTANO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IDC
Provider Gender Code:
M

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:
1063686582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 561
Provider Second Line Business Mailing Address:
BOX 1877
Provider Business Mailing Address City Name:
YAMAGUCHI
Provider Business Mailing Address State Name:
FPO AP
Provider Business Mailing Address Postal Code:
96310 0019
Provider Business Mailing Address Country Code:
JP
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 561
Provider Second Line Business Practice Location Address:
BOX 1877
Provider Business Practice Location Address City Name:
YAMAGUCHI
Provider Business Practice Location Address State Name:
FPO AP
Provider Business Practice Location Address Postal Code:
96310 0019
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
315-253-6164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2008

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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