1720292782 NPI number — MRS. JULITA GLORIA PEZZANO LPCC

Table of content: MRS. JULITA GLORIA PEZZANO LPCC (NPI 1720292782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720292782 NPI number — MRS. JULITA GLORIA PEZZANO LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEZZANO
Provider First Name:
JULITA
Provider Middle Name:
GLORIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAXON
Provider Other First Name:
JULITA
Provider Other Middle Name:
GLORIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720292782
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:
PO BOX 66033
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87193-6033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-450-5500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 PARADISE BLVD NW
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-450-5500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2007

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: 101YP2500X , with the licence number:  0100131 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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