1609358621 NPI number — MARIBEL ORTIZ DOUGLAS

Table of content: MARIBEL ORTIZ DOUGLAS (NPI 1609358621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609358621 NPI number — MARIBEL ORTIZ DOUGLAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ DOUGLAS
Provider First Name:
MARIBEL
Provider Middle Name:
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:
1609358621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CHICOPEE HIGH SCHOOL
Provider Second Line Business Mailing Address:
820 FRONT STREET
Provider Business Mailing Address City Name:
CHICOPEE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-594-3437
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CITY OF CHICOPEE
Provider Second Line Business Practice Location Address:
80 CHURCH STREET
Provider Business Practice Location Address City Name:
CHICOPEE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01020-0102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-594-3437
Provider Business Practice Location Address Fax Number:
413-594-3500
Provider Enumeration Date:
09/06/2018

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: 1041S0200X , with the licence number:  110430 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110025828C , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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