1669906293 NPI number — ROBERTO CARMAGNANI PESTANA

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 1669906293 NPI number — ROBERTO CARMAGNANI PESTANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARMAGNANI PESTANA
Provider First Name:
ROBERTO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1669906293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RUA HADDOCK LOBO, 1129 APT 141
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAO PAULO
Provider Business Mailing Address State Name:
SAO PAULO
Provider Business Mailing Address Postal Code:
01414003
Provider Business Mailing Address Country Code:
BR
Provider Business Mailing Address Telephone Number:
5511992747870
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 HOLCOMBE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-745-0939
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2017

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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