1639338270 NPI number — RICHARD JOHN ANAYA PAC

Table of content: RICHARD JOHN ANAYA PAC (NPI 1639338270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639338270 NPI number — RICHARD JOHN ANAYA PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANAYA
Provider First Name:
RICHARD
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
M

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:
1639338270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2022 MURCHISON DR 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79902-3058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-533-5388
Provider Business Mailing Address Fax Number:
915-533-0868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7920 DONIPHAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79821-7628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-886-3399
Provider Business Practice Location Address Fax Number:
915-886-2999
Provider Enumeration Date:
06/09/2008

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: 363AM0700X , with the licence number:  PA00416 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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