1770542581 NPI number — MR. EDDIE FERNANDO FIGUEROALOPEZ IDC

Table of content: MR. EDDIE FERNANDO FIGUEROALOPEZ IDC (NPI 1770542581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770542581 NPI number — MR. EDDIE FERNANDO FIGUEROALOPEZ IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIGUEROALOPEZ
Provider First Name:
EDDIE
Provider Middle Name:
FERNANDO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IDC
Provider Gender Code:
M

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

NPI Number Information

NPI Number:
1770542581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 466 BOX 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIEGO GARCIA
Provider Business Mailing Address State Name:
BRITISH INDIAN OCEAN TERRITORY
Provider Business Mailing Address Postal Code:
FPO AP 965950003
Provider Business Mailing Address Country Code:
IO
Provider Business Mailing Address Telephone Number:
0112463704211
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1907 E 15TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-218-0356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2006

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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