1437718129 NPI number — IVO KELLI ACHUO

Table of content: MR. ROBERT ANTHONY EVERETTE SA-C (NPI 1760692875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437718129 NPI number — IVO KELLI ACHUO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACHUO
Provider First Name:
IVO
Provider Middle Name:
KELLI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1437718129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 W BAY AREA BLVD STE 602
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77598-4042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-871-4099
Provider Business Mailing Address Fax Number:
281-994-7449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11914 ASTORIA BLVD STE 590
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-871-4099
Provider Business Practice Location Address Fax Number:
281-994-7449
Provider Enumeration Date:
06/06/2019

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: 363LF0000X , with the licence number:  AP141558 , 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)

  • Identifier: F04190281 . This is a "FNP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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