1700308616 NPI number — EMMA REYES ARQUITOLA CRNP

Table of content: EMMA REYES ARQUITOLA CRNP (NPI 1700308616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700308616 NPI number — EMMA REYES ARQUITOLA CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARQUITOLA
Provider First Name:
EMMA
Provider Middle Name:
REYES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1700308616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 AFFLINK PL STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35406-2289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-366-9740
Provider Business Mailing Address Fax Number:
205-344-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 ADELE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAINBOW
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
(256) 442-8033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2017

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: 363LF0000X , with the licence number:  F06171960 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: F06171960 . This is a "AANPCB CERTIFICATION NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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