1326480872 NPI number — DENALI CRT, LLC

Table of content: (NPI 1326480872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326480872 NPI number — DENALI CRT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENALI CRT, 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:
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:
1326480872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10200 NW 25TH ST STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33172-5922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-602-0268
Provider Business Mailing Address Fax Number:
954-477-7706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10200 NW 25TH ST STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33172-5922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-602-0268
Provider Business Practice Location Address Fax Number:
954-477-7706
Provider Enumeration Date:
07/25/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
KARINA
Authorized Official Middle Name:
VICTORIA
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
305-602-8074

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH8888 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WC1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WH0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2055X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 0051701 , 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: 017511700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 693385896 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017511700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".