1184865107 NPI number — SHIRLINA LIA ALCALA N.P.

Table of content: MARIA YESENIA TRINIDAD (NPI 1205447950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184865107 NPI number — SHIRLINA LIA ALCALA N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALCALA
Provider First Name:
SHIRLINA
Provider Middle Name:
LIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILL
Provider Other First Name:
SHIRLINA
Provider Other Middle Name:
LIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184865107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 593
Provider Second Line Business Mailing Address:
200 POCAHONTAS TRAIL
Provider Business Mailing Address City Name:
WHITE SULPHUR SPRINGS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24986-0593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-536-5030
Provider Business Mailing Address Fax Number:
304-536-5031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9870 GATEWAY BLVD N
Provider Second Line Business Practice Location Address:
SUITE B7
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79924-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-751-5245
Provider Business Practice Location Address Fax Number:
915-751-5255
Provider Enumeration Date:
03/20/2009

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: 363LF0000X , with the licence number:  AP117861 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2898397-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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