1124246061 NPI number — TALI ROMBRO DO

Table of content: TALI ROMBRO DO (NPI 1124246061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124246061 NPI number — TALI ROMBRO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMBRO
Provider First Name:
TALI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1124246061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 N. UNIVERSITY DRIVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-755-1411
Provider Business Mailing Address Fax Number:
954-755-8315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N. UNIVERSITY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-755-1411
Provider Business Practice Location Address Fax Number:
954-755-8315
Provider Enumeration Date:
04/24/2007

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: 207V00000X , with the licence number:  OS10025 , 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)

  • Identifier: 278843800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109515 . This is a "USA/MCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10476 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 011725700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com