1386296366 NPI number — DR. LINA MARCELA RENGIFO BEDOYA MD

Table of content: DR. LINA MARCELA RENGIFO BEDOYA MD (NPI 1386296366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386296366 NPI number — DR. LINA MARCELA RENGIFO BEDOYA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RENGIFO BEDOYA
Provider First Name:
LINA
Provider Middle Name:
MARCELA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1386296366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 RIVERFRONT BLVD STE 710
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34205-8812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-776-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
712 39TH ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34205-2454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-748-4602
Provider Business Practice Location Address Fax Number:
941-567-3361
Provider Enumeration Date:
07/10/2019

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:  ME158910 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com