1659750230 NPI number — SHERINE TRESA JOSE DO

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 1659750230 NPI number — SHERINE TRESA JOSE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSE
Provider First Name:
SHERINE
Provider Middle Name:
TRESA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

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:
1659750230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 360541
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15251-6541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-525-9900
Provider Business Mailing Address Fax Number:
469-333-7988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5950 GARLAND BLVD SOUTH
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75043-7504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-525-9900
Provider Business Practice Location Address Fax Number:
469-333-7988
Provider Enumeration Date:
05/28/2015

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: 207Q00000X , with the licence number:  S2073 , 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)

  • Identifier: 398653101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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