1629560818 NPI number — LAS PALMAS DEL SOL INTERNAL MEDICINE, PLLC

Table of content: (NPI 1629560818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629560818 NPI number — LAS PALMAS DEL SOL INTERNAL MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAS PALMAS DEL SOL INTERNAL MEDICINE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629560818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 HEALTH PARK DR FL HP-2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-4525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-327-7600
Provider Business Mailing Address Fax Number:
866-346-1626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N OREGON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-3524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-307-4631
Provider Business Practice Location Address Fax Number:
915-307-3683
Provider Enumeration Date:
06/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
REBOK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
GROUP VP/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
615-372-5004

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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