1528318771 NPI number — RIOBE INSTITUTE OF HOLISTIC GYNECOLOGY, PLLC

Table of content: (NPI 1528318771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528318771 NPI number — RIOBE INSTITUTE OF HOLISTIC GYNECOLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIOBE INSTITUTE OF HOLISTIC GYNECOLOGY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1528318771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 SE OCEAN BLVD
Provider Second Line Business Mailing Address:
SUITE 200-B
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34996-3332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-266-4258
Provider Business Mailing Address Fax Number:
772-219-8111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 SE OCEAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 200-B
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34996-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-266-4258
Provider Business Practice Location Address Fax Number:
772-219-8111
Provider Enumeration Date:
09/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RIOBE
Authorized Official First Name:
MYLAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
772-266-4258

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  ME82630 , 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)





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