1588063358 NPI number — MRS. VALENTINA MARIE FEY-HAGGARD ATC, CEIS

Table of content: MRS. VALENTINA MARIE FEY-HAGGARD ATC, CEIS (NPI 1588063358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588063358 NPI number — MRS. VALENTINA MARIE FEY-HAGGARD ATC, CEIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEY-HAGGARD
Provider First Name:
VALENTINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ATC, CEIS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FEY
Provider Other First Name:
VALENTINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588063358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5949 W RAYMOND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46241-4348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-908-0040
Provider Business Mailing Address Fax Number:
317-486-2194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14700 W SCHULTE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRACY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95377-8628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-908-0040
Provider Business Practice Location Address Fax Number:
209-836-8280
Provider Enumeration Date:
08/18/2014

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: 2255A2300X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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