1629597646 NPI number — SAANVI GROUP OF PENNSYLVANIA LLC

Table of content: MARIE-THERESE LOZADA UMALI REGISTERED NURSE (NPI 1497276760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629597646 NPI number — SAANVI GROUP OF PENNSYLVANIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAANVI GROUP OF PENNSYLVANIA LLC
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:
6
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:
1629597646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 W TILGHMAN ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-9101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-266-3999
Provider Business Mailing Address Fax Number:
310-266-3399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 W TILGHMAN ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-266-3999
Provider Business Practice Location Address Fax Number:
310-266-3399
Provider Enumeration Date:
09/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
NAGIREDDY
Authorized Official First Name:
HARISHANTHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER/OWNER
Authorized Official Telephone Number:
317-652-1584

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  04950501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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