1245966498 NPI number — MARITES EXUME

Table of content: MARITES EXUME (NPI 1245966498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245966498 NPI number — MARITES EXUME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EXUME
Provider First Name:
MARITES
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEXUME
Provider Other First Name:
TAI
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:
1245966498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
238 BRADMERE LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23608-1090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-792-9382
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1006 SETTLERS LANDING RD, WILLIE O. LAWTON BUILDING
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-727-5617
Provider Business Practice Location Address Fax Number:
757-637-2375
Provider Enumeration Date:
07/29/2022

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:  0704014417 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0704014417 . This is a "RESIDENT IN COUNSELING LISCENSE NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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