1366597882 NPI number — MARIA T BARRERA

Table of content: (NPI 1366597882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366597882 NPI number — MARIA T BARRERA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA T BARRERA
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:
6
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:
1366597882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4352
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78523-4352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-574-0596
Provider Business Mailing Address Fax Number:
956-574-0086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3670 BOCA CHICA BLVD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78521-3967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-574-0596
Provider Business Practice Location Address Fax Number:
956-574-0086
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARRERA
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
956-574-0596

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  014979 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001025923 . This is a "DADS - MEDICAID CONTRACT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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