1538205281 NPI number — DEJUANA LYNETTE RIAT PA-C

Table of content: DEJUANA LYNETTE RIAT PA-C (NPI 1538205281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538205281 NPI number — DEJUANA LYNETTE RIAT PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIAT
Provider First Name:
DEJUANA
Provider Middle Name:
LYNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1538205281
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:
18TH MEDCOM
Provider Second Line Business Mailing Address:
ATTN DCCS-QM (CREDENTIALS)
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96205
Provider Business Mailing Address Country Code:
KR
Provider Business Mailing Address Telephone Number:
01182279166027
Provider Business Mailing Address Fax Number:
01182279178110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
D CO 168TH MED BN
Provider Second Line Business Practice Location Address:
BOX 36-B CAMP WALKER
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96218
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
12257090691
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2007

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: 363A00000X , with the licence number:  1038258 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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