1144296971 NPI number — DR. ROSE-VALENTINE A GONCALVES MD

Table of content: DR. ROSE-VALENTINE A GONCALVES MD (NPI 1144296971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144296971 NPI number — DR. ROSE-VALENTINE A GONCALVES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONCALVES
Provider First Name:
ROSE-VALENTINE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANTOINE
Provider Other First Name:
ROSE-VALENTINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144296971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
US NAVAL HOSPITAL YOKOSUKA, JAPAN
Provider Second Line Business Mailing Address:
PSC 475 BOX 1, CODE 034
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96350-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
01181468165564
Provider Business Mailing Address Fax Number:
01181468168650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 475
Provider Second Line Business Practice Location Address:
US NAVAL HOSPITAL YOKOSUKA, BOX 1, CODE 034
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96350-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
01181468165564
Provider Business Practice Location Address Fax Number:
01181468168650
Provider Enumeration Date:
02/23/2006

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: 207P00000X , with the licence number:  0101241668 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: A92961 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 019788700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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