1639523699 NPI number — STUDIO VSC PREVENTIVE HEALTH MAINTENANCE OF THE FEET

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639523699 NPI number — STUDIO VSC PREVENTIVE HEALTH MAINTENANCE OF THE FEET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STUDIO VSC PREVENTIVE HEALTH MAINTENANCE OF THE FEET
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:
1639523699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 8TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87102-4006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-516-9869
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 8TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87102-4006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-516-9869
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CHAVIRA
Authorized Official First Name:
VIRGINIA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
REGISTERED COSMETOLOGIST
Authorized Official Telephone Number:
505-516-9869

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  CO039083 , 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)

  • Identifier: 080160135 . This is a "US FEDERAL SYSTEM OF AWARD MANAGEMENT BELOW IS DUNS # HERE IS CAGE CODE 7KCN9" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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