1730465352 NPI number — ANN BATES LEACH HOSPITAL/BASCOM PALMER EYE INSTITUTE

Table of content: GRACE MARIE SAKURADA MS, LMFT (NPI 1780128793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730465352 NPI number — ANN BATES LEACH HOSPITAL/BASCOM PALMER EYE INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANN BATES LEACH HOSPITAL/BASCOM PALMER EYE INSTITUTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730465352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 NW 17TH ST
Provider Second Line Business Mailing Address:
SUITE 10A
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33136-1135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-326-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 NW 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 10A
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-326-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
OWENS
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF, DIVISION OF HAND SURGERY
Authorized Official Telephone Number:
305-326-6590

Provider Taxonomy Codes

  • Taxonomy code: 284300000X , with the licence number:  9256543 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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