1366492662 NPI number — MISS MARIA EDEN AGUILAR GIANAN NP

Table of content: MISS MARIA EDEN AGUILAR GIANAN NP (NPI 1366492662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366492662 NPI number — MISS MARIA EDEN AGUILAR GIANAN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIANAN
Provider First Name:
MARIA EDEN
Provider Middle Name:
AGUILAR
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIANAN
Provider Other First Name:
EDEN
Provider Other Middle Name:
AGUILAR
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366492662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 PROVIDENCE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02026-6811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-724-7348
Provider Business Mailing Address Fax Number:
781-329-0306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 WALDO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01730-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-724-7348
Provider Business Practice Location Address Fax Number:
781-329-0306
Provider Enumeration Date:
05/10/2006

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: 363LA2200X , with the licence number:  175294 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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