1497233175 NPI number — CHRISTINE JOY BANGILAN DEOCOS RN

Table of content: CHRISTINE JOY BANGILAN DEOCOS RN (NPI 1497233175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497233175 NPI number — CHRISTINE JOY BANGILAN DEOCOS RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEOCOS
Provider First Name:
CHRISTINE JOY
Provider Middle Name:
BANGILAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BANGILAN
Provider Other First Name:
CHRISTINE JOY
Provider Other Middle Name:
CIUDAD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSN, RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497233175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 PALM DESERT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANVEL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77578-3295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-567-6357
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 PALM DESERT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANVEL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77578-3295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-567-6357
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2018

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: 163W00000X , with the licence number:  941680 , 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)





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