1336854710 NPI number — CLINICA DE CABEZ Y CUELLO AMD CARE CHOPO DIAGNOSTICS

Table of content: (NPI 1336854710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336854710 NPI number — CLINICA DE CABEZ Y CUELLO AMD CARE CHOPO DIAGNOSTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA DE CABEZ Y CUELLO AMD CARE CHOPO DIAGNOSTICS
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:
1336854710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5830 E 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82609-4308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BUENOS AIRES 2779 #3
Provider Second Line Business Practice Location Address:
COL PROVIDENCIA
Provider Business Practice Location Address City Name:
GUADALAJARA
Provider Business Practice Location Address State Name:
MEXICO
Provider Business Practice Location Address Postal Code:
44630
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
888-449-7799
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2023

Additional Information

Authorized Official

Authorized Official Last Name:
EZQUERRA
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
Authorized Official Title or Position:
MGR
Authorized Official Telephone Number:
888-449-7799

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11082001 . This is a "STATE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com