1730353251 NPI number — MS. DEZIRE CAVITTA MA, NCC

Table of content: MS. DEZIRE CAVITTA MA, NCC (NPI 1730353251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730353251 NPI number — MS. DEZIRE CAVITTA MA, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAVITTA
Provider First Name:
DEZIRE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, NCC
Provider Gender Code:
X

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAVITTA
Provider Other First Name:
D
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, NCC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1730353251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
364 ARCHIE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97402-6569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-727-2273
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
364 ARCHIE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97402-6569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-727-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2008

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: R9595 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1730353251 . This is a "NPI" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: BX21058A , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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