1366875643 NPI number — MISS GINA MARIA TULIMERO D.P.T.

Table of content: MISS GINA MARIA TULIMERO D.P.T. (NPI 1366875643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366875643 NPI number — MISS GINA MARIA TULIMERO D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TULIMERO
Provider First Name:
GINA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
F

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:
1366875643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4730 BLUE DIAMOND RD STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89139-7660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-909-6893
Provider Business Mailing Address Fax Number:
702-909-5387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4730 BLUE DIAMOND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89139-7662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-909-6893
Provider Business Practice Location Address Fax Number:
702-909-5387
Provider Enumeration Date:
08/09/2013

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: 225100000X , with the licence number:  2859 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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