1205955143 NPI number — MS. MARIAN M GIRMUS OTRL

Table of content: MS. MARIAN M GIRMUS OTRL (NPI 1205955143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205955143 NPI number — MS. MARIAN M GIRMUS OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIRMUS
Provider First Name:
MARIAN
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
MARIAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205955143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 CALIENTE RD STE 6
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:
87508-9208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-436-1163
Provider Business Mailing Address Fax Number:
505-636-5172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 CALIENTE RD
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87508-9208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-603-4424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2007

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: 225X00000X , with the licence number:  1771 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 85502219 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com