1427544022 NPI number — MS. FABIOLA ALEJANDRA MIESES PUN MD

Table of content: MS. FABIOLA ALEJANDRA MIESES PUN MD (NPI 1427544022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427544022 NPI number — MS. FABIOLA ALEJANDRA MIESES PUN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIESES PUN
Provider First Name:
FABIOLA
Provider Middle Name:
ALEJANDRA
Provider Name Prefix Text:
MS.
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:
1427544022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ST. VINCENT'S MEDICAL CENTER
Provider Second Line Business Mailing Address:
2800 MAIN STREET, DEPARTMENT OF MEDICINE
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
475-210-5791
Provider Business Mailing Address Fax Number:
475-210-5022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 PHOENIX AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06702-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-756-8021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2018

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: 207R00000X , with the licence number:  67321 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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