1780140830 NPI number — EVA GEANETTE GONZALEZ CAREY

Table of content: EVA GEANETTE GONZALEZ CAREY (NPI 1780140830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780140830 NPI number — EVA GEANETTE GONZALEZ CAREY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ CAREY
Provider First Name:
EVA
Provider Middle Name:
GEANETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALEZ
Provider Other First Name:
EVA
Provider Other Middle Name:
GEANETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780140830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 BARBARA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH WEYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02190-1303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-932-5955
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02339-2315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-371-8820
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2019

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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