1750004644 NPI number — ALEJANDRA JOSELIE AGUAYO RODRIGUEZ BACHELORS

Table of content: ALEJANDRA JOSELIE AGUAYO RODRIGUEZ BACHELORS (NPI 1750004644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750004644 NPI number — ALEJANDRA JOSELIE AGUAYO RODRIGUEZ BACHELORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGUAYO RODRIGUEZ
Provider First Name:
ALEJANDRA
Provider Middle Name:
JOSELIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BACHELORS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGUAYO RODRIGUEZ
Provider Other First Name:
ALEJANDRA
Provider Other Middle Name:
JOSELINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PLD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750004644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1137 S SHERMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72701-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-249-4234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 SE 22ND ST STE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72712-5180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-289-8465
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2022

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: 133NN1002X , with the licence number:  PLD314 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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