1710121892 NPI number — MRS. IMEE SARMIENTO KISER IDMT

Table of content: MRS. IMEE SARMIENTO KISER IDMT (NPI 1710121892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710121892 NPI number — MRS. IMEE SARMIENTO KISER IDMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KISER
Provider First Name:
IMEE
Provider Middle Name:
SARMIENTO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
IDMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTANETO
Provider Other First Name:
IMEE
Provider Other Middle Name:
SARMIENTO
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710121892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIT 14010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96543-4010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-366-3231
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36TH MDG
Provider Second Line Business Practice Location Address:
BUILDING 26012 CAROLINES AVENUE
Provider Business Practice Location Address City Name:
ANDERSEN AFB
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-366-3231
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2009

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: 1710I1003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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