1144662925 NPI number — MRS. VANESSA MAE FERNANDEZ DULIG RPT

Table of content: MRS. VANESSA MAE FERNANDEZ DULIG RPT (NPI 1144662925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144662925 NPI number — MRS. VANESSA MAE FERNANDEZ DULIG RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DULIG
Provider First Name:
VANESSA MAE
Provider Middle Name:
FERNANDEZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERNANDEZ
Provider Other First Name:
VANESSA MAE
Provider Other Middle Name:
ROMIAS
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144662925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4011 N PINE ISLAND RD
Provider Second Line Business Mailing Address:
APT.1-404
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33351-6520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-599-3864
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4011 N PINE ISLAND RD
Provider Second Line Business Practice Location Address:
APT.1-404
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33351-6520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-599-3864
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2013

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:  J1-0002918 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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