1275887424 NPI number — CHARLOTTE K YIANAKOPULOS-VEATCH

Table of content: CHARLOTTE K YIANAKOPULOS-VEATCH (NPI 1275887424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275887424 NPI number — CHARLOTTE K YIANAKOPULOS-VEATCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YIANAKOPULOS-VEATCH
Provider First Name:
CHARLOTTE
Provider Middle Name:
K
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:
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:
1275887424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1304 CHINOOK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81001-1851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-545-2746
Provider Business Mailing Address Fax Number:
719-584-0110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1026 W ABRIENDO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81004-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-545-2746
Provider Business Practice Location Address Fax Number:
719-545-4100
Provider Enumeration Date:
11/08/2012

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: 103TC0700X , with the licence number:  PSY.0002067 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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