1144770231 NPI number — SELFIE TALK, LLC

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 1144770231 NPI number — SELFIE TALK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SELFIE TALK, LLC
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:
1144770231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 900184
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMESTEAD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33090-0184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-373-5343
Provider Business Mailing Address Fax Number:
844-373-5343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9299 SW 152ND ST
Provider Second Line Business Practice Location Address:
SUITE 200G
Provider Business Practice Location Address City Name:
PALMETTO BAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33157-1737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-373-5343
Provider Business Practice Location Address Fax Number:
844-373-5343
Provider Enumeration Date:
10/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
OCASIO
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
844-373-5343

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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)





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