1750760914 NPI number — MRS. MARIA ALEJANDRA LERMA P.A.

Table of content: MRS. MARIA ALEJANDRA LERMA P.A. (NPI 1750760914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750760914 NPI number — MRS. MARIA ALEJANDRA LERMA P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LERMA
Provider First Name:
MARIA
Provider Middle Name:
ALEJANDRA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EGUILUZ
Provider Other First Name:
MARIA
Provider Other Middle Name:
ALEJANDRA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750760914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMMING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30028-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-887-1668
Provider Business Mailing Address Fax Number:
770-781-9937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5959 HIGHWAY 53 E STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAWSONVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30534-6288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-887-1668
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2015

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: 363A00000X , with the licence number:  7555 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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