1598342891 NPI number — MR. THIAGO BOMFIM MOREIRA MS, SPECIALIST, BA

Table of content: MR. THIAGO BOMFIM MOREIRA MS, SPECIALIST, BA (NPI 1598342891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598342891 NPI number — MR. THIAGO BOMFIM MOREIRA MS, SPECIALIST, BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOREIRA
Provider First Name:
THIAGO
Provider Middle Name:
BOMFIM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, SPECIALIST, BA
Provider Gender Code:
M

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:
1598342891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RUA FRANCISCO PESSOA 491/102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAO PAULO
Provider Business Mailing Address State Name:
BRAZIL
Provider Business Mailing Address Postal Code:
05727230
Provider Business Mailing Address Country Code:
BR
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RUA GOMES DE CARVALHO 1356, 5TH FLOOR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAO PAULO
Provider Business Practice Location Address State Name:
SAO PAULO
Provider Business Practice Location Address Postal Code:
05727230
Provider Business Practice Location Address Country Code:
BR
Provider Business Practice Location Address Telephone Number:
540-209-7443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  154587 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06154587 . This is a "FEDERAL PSYCHOLOGY BOARD" identifier . This identifiers is of the category "OTHER".




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