1609964824 NPI number — SAHNTA LEE DI CESARE-PANNUTTI LPAT

Table of content: SAHNTA LEE DI CESARE-PANNUTTI LPAT (NPI 1609964824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609964824 NPI number — SAHNTA LEE DI CESARE-PANNUTTI LPAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DI CESARE-PANNUTTI
Provider First Name:
SAHNTA
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPAT
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:
1609964824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7027 MONTGOMERY BLVD NE
Provider Second Line Business Mailing Address:
STE F
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-1589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-880-0100
Provider Business Mailing Address Fax Number:
505-880-0102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 CALLE BLANCA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORRALES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87048-7825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-264-3933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2006

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: 106H00000X , with the licence number:  0166591 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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