1679694418 NPI number — MISS MARIA CORAZON DULAY AYTONA P.T.DIP.MDT

Table of content: MISS MARIA CORAZON DULAY AYTONA P.T.DIP.MDT (NPI 1679694418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679694418 NPI number — MISS MARIA CORAZON DULAY AYTONA P.T.DIP.MDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYTONA
Provider First Name:
MARIA CORAZON
Provider Middle Name:
DULAY
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
P.T.DIP.MDT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AYTONA
Provider Other First Name:
CORA
Provider Other Middle Name:
DULAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T. DIP.MDT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1679694418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2991 TREVOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUMBERTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28358-5729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-738-4554
Provider Business Mailing Address Fax Number:
910-739-4027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4895 FAYETTEVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358-2162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-738-4554
Provider Business Practice Location Address Fax Number:
910-739-4027
Provider Enumeration Date:
04/02/2007

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: 225100000X , with the licence number:  5811 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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