1568827707 NPI number — VERONICA CECILIA MASIERI

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568827707 NPI number — VERONICA CECILIA MASIERI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASIERI
Provider First Name:
VERONICA
Provider Middle Name:
CECILIA
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:
MASIERI
Provider Other First Name:
VERONICA
Provider Other Middle Name:
CECILIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568827707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2657 CARAMBOLA CIR N # 2657
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCONUT CREEK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33066-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-552-7456
Provider Business Mailing Address Fax Number:
772-675-9100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2657 CARAMBOLA CIR N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COCONUT CREEK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33066-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-552-7456
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2015

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: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 018009100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com