1386831212 NPI number — MRS. YADIRA XIOMARA RANGEL APN

Table of content: MRS. YADIRA XIOMARA RANGEL APN (NPI 1386831212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386831212 NPI number — MRS. YADIRA XIOMARA RANGEL APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANGEL
Provider First Name:
YADIRA
Provider Middle Name:
XIOMARA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1386831212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4813 W 84TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60459-2787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-952-0048
Provider Business Mailing Address Fax Number:
773-665-6027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1S260 SUMMIT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKBROOK TERRACE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60181-3941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-953-6600
Provider Business Practice Location Address Fax Number:
630-953-6619
Provider Enumeration Date:
09/25/2007

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: 364S00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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