1346014776 NPI number — PAIGE HARAZIN

Table of content: PAIGE HARAZIN (NPI 1346014776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346014776 NPI number — PAIGE HARAZIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARAZIN
Provider First Name:
PAIGE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARROW
Provider Other First Name:
PAIGE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346014776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 POLK AVE APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CANAVERAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32920-3046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-416-9150
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3880 CATALINA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TITUSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32796-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-346-8450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2023

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 120304000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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