1265523062 NPI number — PEDIATRIC ASSOCIATES OF IOWA CITY AND CORALVILLE, LLP

Table of content: DR. VIVIAN ANN TAMBURELLO PH.D. (NPI 1174627608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265523062 NPI number — PEDIATRIC ASSOCIATES OF IOWA CITY AND CORALVILLE, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC ASSOCIATES OF IOWA CITY AND CORALVILLE, LLP
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:
1265523062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 E JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IOWA CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52245-2426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-351-1448
Provider Business Mailing Address Fax Number:
319-351-9367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 E JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52245-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-351-1448
Provider Business Practice Location Address Fax Number:
319-351-9367
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALINDO
Authorized Official First Name:
ALEJANDRO
Authorized Official Middle Name:
GONZALO
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
319-351-1448

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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