1306214283 NPI number — PUZZLE BUILDERS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306214283 NPI number — PUZZLE BUILDERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUZZLE BUILDERS
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:
1306214283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 835614
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33283-5614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-632-5566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12840 SW 72ND TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33183-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-632-5566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ALBA
Authorized Official First Name:
TATIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PART OWNER
Authorized Official Telephone Number:
305-632-5566

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116154400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com