1487795019 NPI number — NIRUPAMA TALWALKAR

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487795019 NPI number — NIRUPAMA TALWALKAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NIRUPAMA TALWALKAR
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:
6
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:
1487795019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3843 PENBROOK ST
Provider Second Line Business Mailing Address:
# 52
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79762-6152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-368-4167
Provider Business Mailing Address Fax Number:
432-368-4167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 W ILLINOIS AVE
Provider Second Line Business Practice Location Address:
SUITE 3B1
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79701-3180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-296-2180
Provider Business Practice Location Address Fax Number:
432-368-4167
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TALWALKAR
Authorized Official First Name:
NIRUPAMA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
432-288-5027

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  L3494 , 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 © 2007-2025 www.npivalidator.com