1386985125 NPI number — HELENA H. LIPTAKOVA, MD., PLLC

Table of content: (NPI 1386985125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386985125 NPI number — HELENA H. LIPTAKOVA, MD., PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HELENA H. LIPTAKOVA, MD., PLLC
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:
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:
1386985125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7430 REMCON CIR
Provider Second Line Business Mailing Address:
BLDG B -110
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-544-2455
Provider Business Mailing Address Fax Number:
915-544-3149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9870 GATEWAY BLVD N
Provider Second Line Business Practice Location Address:
SUITE B - 7
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79924-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-751-5245
Provider Business Practice Location Address Fax Number:
915-751-5255
Provider Enumeration Date:
03/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LIPTAKOVA
Authorized Official First Name:
HELENA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
915-751-5245

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  K0894 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com