1790766939 NPI number — MRS. SEEMA JONES PAC

Table of content: MRS. SEEMA JONES PAC (NPI 1790766939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790766939 NPI number — MRS. SEEMA JONES PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
SEEMA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

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:
1790766939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 MAPLE RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRITT ISLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32952-4172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-456-5688
Provider Business Mailing Address Fax Number:
321-751-9362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7125 MURRELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIERA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32940-7999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-242-8790
Provider Business Practice Location Address Fax Number:
321-751-9362
Provider Enumeration Date:
11/07/2005

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:  PA9103386 , 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)

  • Identifier: Y09Z9 . This is a "FLORIDA BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 292548600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9228859 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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