1780056226 NPI number — MISS NINA JUNAINA ABDULLAH M.A.

Table of content: MISS NINA JUNAINA ABDULLAH M.A. (NPI 1780056226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780056226 NPI number — MISS NINA JUNAINA ABDULLAH M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABDULLAH
Provider First Name:
NINA
Provider Middle Name:
JUNAINA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALBATATI
Provider Other First Name:
JUNAINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780056226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19618 STARRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32833-5720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-693-6710
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W PLYMOUTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32720-2753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-402-5169
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2015

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: 106H00000X , with the licence number:  IMT 2210 , 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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