1285177758 NPI number — INTERNAL MEDICINE AND AESTHETICS OF NAPLES LLC

Table of content: (NPI 1285177758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285177758 NPI number — INTERNAL MEDICINE AND AESTHETICS OF NAPLES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE AND AESTHETICS OF NAPLES 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:
6
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:
1285177758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8805 TAMIAMI TRL N
Provider Second Line Business Mailing Address:
UNIT 105
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34108-2525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-699-9499
Provider Business Mailing Address Fax Number:
239-574-1132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1726 MEDICAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34110-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-596-8804
Provider Business Practice Location Address Fax Number:
239-596-8793
Provider Enumeration Date:
11/30/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BLANCO-FRANCO
Authorized Official First Name:
ALEJANDRO
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
239-596-8804

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 305R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 101502200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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