1164866257 NPI number — ARTURO LEONARDO IGNACO SIONGCO SUBIDC

Table of content: ARTURO LEONARDO IGNACO SIONGCO SUBIDC (NPI 1164866257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164866257 NPI number — ARTURO LEONARDO IGNACO SIONGCO SUBIDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIONGCO
Provider First Name:
ARTURO LEONARDO
Provider Middle Name:
IGNACO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SUBIDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIONGCO
Provider Other First Name:
ARTURO
Provider Other Middle Name:
IGNACO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SUB IDC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164866257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 TROUT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROTN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-910-6045
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 TROUT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROTN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-910-6045
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2013

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8481 . This is a "INDEPENDENT DUTY CORPSMAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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