1629748520 NPI number — CENTRO CARDIOVASCULAR CHAPALITA

Table of content: (NPI 1629748520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629748520 NPI number — CENTRO CARDIOVASCULAR CHAPALITA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO CARDIOVASCULAR CHAPALITA
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629748520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1441 WOODMONT LN NW # 1398
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30318-2866
Provider Business Mailing Address Country Code:
US
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:
AV NINO OBRERO 1666
Provider Second Line Business Practice Location Address:
COL CHAPALITA
Provider Business Practice Location Address City Name:
ZAPOPAN
Provider Business Practice Location Address State Name:
JALISCO
Provider Business Practice Location Address Postal Code:
45040
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
333-878-1400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SEGOVIANO
Authorized Official First Name:
VIRGINIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
333-878-1400

Provider Taxonomy Codes

  • Taxonomy code: 207RA0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HSM721001KQ2 . This is a "STATE" identifier . This identifiers is of the category "OTHER".




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