1356866271 NPI number — LALK MEDICA, PA

Table of content: (NPI 1356866271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356866271 NPI number — LALK MEDICA, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LALK MEDICA, PA
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:
1356866271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4659 COHEN AVE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-877-7343
Provider Business Mailing Address Fax Number:
915-877-7318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4659 COHEN AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-877-7343
Provider Business Practice Location Address Fax Number:
915-877-7318
Provider Enumeration Date:
08/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LONGORIA
Authorized Official First Name:
LEONARDO
Authorized Official Middle Name:
ARTURO
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
915-877-7343

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: R1407 . This is a "TEXAS MEDICAL LICENSE #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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