1275867772 NPI number — ZANE ROMANCITO LADAC

Table of content: ZANE ROMANCITO LADAC (NPI 1275867772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275867772 NPI number — ZANE ROMANCITO LADAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMANCITO
Provider First Name:
ZANE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LADAC
Provider Gender Code:
M

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:
1275867772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 339
Provider Second Line Business Mailing Address:
C/O ZUNI RECOVERY CENTER
Provider Business Mailing Address City Name:
ZUNI
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87327-0339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-782-4710
Provider Business Mailing Address Fax Number:
505-782-5880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 D AVE
Provider Second Line Business Practice Location Address:
BLACK ROCK
Provider Business Practice Location Address City Name:
ZUNI
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-782-4710
Provider Business Practice Location Address Fax Number:
505-782-5880
Provider Enumeration Date:
09/30/2009

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: 101YA0400X , with the licence number:  005837 , 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: 28905512 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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