1154396851 NPI number — MR. ANDREW S LLAGUNO MSED ATC CSCS

Table of content: MR. ANDREW S LLAGUNO MSED ATC CSCS (NPI 1154396851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154396851 NPI number — MR. ANDREW S LLAGUNO MSED ATC CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LLAGUNO
Provider First Name:
ANDREW
Provider Middle Name:
S
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSED ATC CSCS
Provider Gender Code:
M

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:
1154396851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
97C SAND PLAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02813-3837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-364-8066
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 KEANEY RD
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02881-1111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-874-5230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2006

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: 2255A2300X , with the licence number:  139 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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