1669664355 NPI number — DR. FE MARIE TERESE EVANGELISTA D.C.

Table of content: DR. FE MARIE TERESE EVANGELISTA D.C. (NPI 1669664355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669664355 NPI number — DR. FE MARIE TERESE EVANGELISTA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANGELISTA
Provider First Name:
FE MARIE
Provider Middle Name:
TERESE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1669664355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 GULF FWY S
Provider Second Line Business Mailing Address:
SUITE 122
Provider Business Mailing Address City Name:
LEAGUE CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77573-5153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-557-3339
Provider Business Mailing Address Fax Number:
832-932-5223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 GULF FWY S
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
LEAGUE CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77573-5153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-557-3339
Provider Business Practice Location Address Fax Number:
832-932-5223
Provider Enumeration Date:
08/16/2007

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: 111NI0900X , with the licence number:  10342 , 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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