1720118524 NPI number — TRICIA ATOIGUE LIZAMA MSW

Table of content: TRICIA ATOIGUE LIZAMA MSW (NPI 1720118524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720118524 NPI number — TRICIA ATOIGUE LIZAMA MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIZAMA
Provider First Name:
TRICIA
Provider Middle Name:
ATOIGUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1720118524
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:
REFLECTION CENTER 222 CHALAN SANTO PAPA
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
HAGATNA
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96910-5172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-477-5715
Provider Business Mailing Address Fax Number:
671-477-5714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 CHALAN SANTO PAPA REFELCTION CENTER
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HAGATNA
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96910-5172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-477-5715
Provider Business Practice Location Address Fax Number:
671-472-6221
Provider Enumeration Date:
03/07/2007

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: 106H00000X , with the licence number:  0000075 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: IMFT 0000075 . This is a "PROFESSIONAL LICENSING" identifier , issued by the state of ( GU ) . This identifiers is of the category "OTHER".




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