1528485117 NPI number — CLAUDIA IVETTE OCON

Table of content: CLAUDIA IVETTE OCON (NPI 1528485117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528485117 NPI number — CLAUDIA IVETTE OCON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OCON
Provider First Name:
CLAUDIA
Provider Middle Name:
IVETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1528485117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
385 CALLE DE ALEGRA
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-526-1105
Provider Business Mailing Address Fax Number:
575-524-4266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 S MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-647-2841
Provider Business Practice Location Address Fax Number:
575-647-2898
Provider Enumeration Date:
03/21/2014

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 18677037 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72545 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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