1336200591 NPI number — AMINDA OSORIO-MODRELL DDS

Table of content: AMINDA OSORIO-MODRELL DDS (NPI 1336200591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336200591 NPI number — AMINDA OSORIO-MODRELL DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSORIO-MODRELL
Provider First Name:
AMINDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1336200591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3176 DANVILLE BLVD
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
ALAMO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-837-6052
Provider Business Mailing Address Fax Number:
925-837-3768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3176 DANVILLE BLVD
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
ALAMO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-837-6052
Provider Business Practice Location Address Fax Number:
925-837-3768
Provider Enumeration Date:
12/12/2006

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: 122300000X , with the licence number:  A2348675 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 54022 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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