1356323679 NPI number — DR. SOCORRO AGGABAO TALOSIG PEDIATRICS

Table of content: DR. SOCORRO AGGABAO TALOSIG PEDIATRICS (NPI 1356323679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356323679 NPI number — DR. SOCORRO AGGABAO TALOSIG PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALOSIG
Provider First Name:
SOCORRO
Provider Middle Name:
AGGABAO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PEDIATRICS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TALOSIG
Provider Other First Name:
SOCORRO
Provider Other Middle Name:
AGGABAO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PEDIATRICS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356323679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 S WINFREE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77535-2942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-258-2624
Provider Business Mailing Address Fax Number:
936-258-2488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 S WINFREE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77535-2942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-258-2624
Provider Business Practice Location Address Fax Number:
936-258-2488
Provider Enumeration Date:
11/14/2005

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: 208000000X , with the licence number:  F6129 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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