1467434746 NPI number — ELIZABETH MARIE DE AGUIRRE DDS

Table of content: ELIZABETH MARIE DE AGUIRRE DDS (NPI 1467434746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467434746 NPI number — ELIZABETH MARIE DE AGUIRRE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE AGUIRRE
Provider First Name:
ELIZABETH
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1467434746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2750 W 68TH ST
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33016-5446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-826-3255
Provider Business Mailing Address Fax Number:
305-826-3898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 S DOUGLAS RD
Provider Second Line Business Practice Location Address:
150
Provider Business Practice Location Address City Name:
CORAL GABLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33134-3157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-446-2226
Provider Business Practice Location Address Fax Number:
305-446-8458
Provider Enumeration Date:
11/14/2005

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: 122300000X , with the licence number:  DN0015008 , 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)

  • Identifier: 001666800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003893363 . This is a "NPI FOR EXPERT SMILES OFFICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1225316888 . This is a "NPI FOR GABLES OFFICE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 100948300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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