1700119062 NPI number — DEBORAH E CARRANZA

Table of content: DEBORAH E CARRANZA (NPI 1700119062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700119062 NPI number — DEBORAH E CARRANZA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRANZA
Provider First Name:
DEBORAH
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUGHES-CARRANZA
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700119062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
164 SUMMIT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02906-2853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-793-4300
Provider Business Mailing Address Fax Number:
401-793-4312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 ELLENFIELD ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02905-4513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-444-6779
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2009

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: 1041C0700X , with the licence number:  01121 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ISW01121 . This is a "LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".