1174856629 NPI number — CARMEL YVETTE GARDNER ADULT SER PRG MAN

Table of content: CESAR ALCARAZ (NPI 1871059972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174856629 NPI number — CARMEL YVETTE GARDNER ADULT SER PRG MAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDNER
Provider First Name:
CARMEL
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ADULT SER PRG MAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARDNER PICKETT
Provider Other First Name:
YVETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1174856629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 28220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87592-8220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-471-5006
Provider Business Mailing Address Fax Number:
505-820-9220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 TOWNSGATE PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88101-3714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-742-2620
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2009

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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