1255864179 NPI number — ONE SPINE INSTITUTE, LLC

Table of content: DR. AYMME SOFIA BELEN DMD (NPI 1326099375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255864179 NPI number — ONE SPINE INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE SPINE INSTITUTE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255864179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1633 ST. CHARLES AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-680-8383
Provider Business Mailing Address Fax Number:
504-680-8384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3530 HOUMA BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-680-8383
Provider Business Practice Location Address Fax Number:
504-680-8384
Provider Enumeration Date:
04/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GRAFF
Authorized Official First Name:
NATE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE DIRECTOR
Authorized Official Telephone Number:
504-680-8383

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  MD.202324 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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