1346439759 NPI number — RIO VISTA OB-GYN ASSOCIATES LIMITED PARTNERSHIP

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 1346439759 NPI number — RIO VISTA OB-GYN ASSOCIATES LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIO VISTA OB-GYN ASSOCIATES LIMITED PARTNERSHIP
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:
1346439759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 SE 3RD AVE
Provider Second Line Business Mailing Address:
SUITE 701
Provider Business Mailing Address City Name:
FT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33316-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-772-3960
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 SE 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 701
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33316-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-772-3960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POULIOT
Authorized Official First Name:
REYNALD
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
954-772-3960

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , 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)





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