1508928532 NPI number — DR. JANE RAEL D.O.M.

Table of content: DR. JANE RAEL D.O.M. (NPI 1508928532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508928532 NPI number — DR. JANE RAEL D.O.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAEL
Provider First Name:
JANE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.M.
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:
1508928532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1512 RIO GRANDE BLVD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS LUNAS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87031-6130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-565-4325
Provider Business Mailing Address Fax Number:
505-866-0639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19499 HWY 314
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELEN
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-565-4325
Provider Business Practice Location Address Fax Number:
505-866-0639
Provider Enumeration Date:
12/15/2006

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: 171100000X , with the licence number:  603 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2122627 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: R93E . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com