1134475312 NPI number — MRS. DOBEN FERRER ATUN PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134475312 NPI number — MRS. DOBEN FERRER ATUN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATUN
Provider First Name:
DOBEN
Provider Middle Name:
FERRER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1134475312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16089 POPPYSEED CIR
Provider Second Line Business Mailing Address:
UNIT 2008
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33484-6314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-496-7993
Provider Business Mailing Address Fax Number:
561-496-0589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8545 N MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NILES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60714-1974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-606-1764
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2012

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: 225100000X , with the licence number:  070.017839 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 070.017839 . This is a "ILLINOIS PROFESSIONAL REGULATION PT LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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