1235964479 NPI number — PRIMAVERA DE JESUS ALMANZAR MA, RMHCI

Table of content: PRIMAVERA DE JESUS ALMANZAR MA, RMHCI (NPI 1235964479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235964479 NPI number — PRIMAVERA DE JESUS ALMANZAR MA, RMHCI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALMANZAR
Provider First Name:
PRIMAVERA
Provider Middle Name:
DE JESUS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, RMHCI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALMANZAR GARABITO
Provider Other First Name:
PRIMAVERA
Provider Other Middle Name:
DE JESUS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, RMHCI
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235964479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
237 LOOKOUT PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751-8433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-801-4716
Provider Business Mailing Address Fax Number:
321-203-2512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
237 LOOKOUT PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAITLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32751-8433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-801-4716
Provider Business Practice Location Address Fax Number:
321-203-2512
Provider Enumeration Date:
09/06/2024

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: 101YM0800X , with the licence number:  IMH25338 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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