1104287689 NPI number — INSPIRA MENTAL HEALTH MANAGEMENT

Table of content: DR. OBIOMA NNENE MADUAKOR MD (NPI 1215179155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104287689 NPI number — INSPIRA MENTAL HEALTH MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSPIRA MENTAL HEALTH MANAGEMENT
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:
1104287689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9809
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-9809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-704-0705
Provider Business Mailing Address Fax Number:
787-744-7444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 3 PLAZA NORESTE SHOPPING CENTER
Provider Second Line Business Practice Location Address:
MARGINAL URB VILLA DE LOIZA
Provider Business Practice Location Address City Name:
LOIZA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-704-0705
Provider Business Practice Location Address Fax Number:
787-744-7444
Provider Enumeration Date:
03/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
VARELA
Authorized Official First Name:
ALBERTO
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-704-0705

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  60895 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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