1811425481 NPI number — LEYNIBEL N LOPEZ APONTE MSWI

Table of content: LEYNIBEL N LOPEZ APONTE MSWI (NPI 1811425481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811425481 NPI number — LEYNIBEL N LOPEZ APONTE MSWI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ APONTE
Provider First Name:
LEYNIBEL
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSWI
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:
1811425481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1924
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84091-1924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-982-1328
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 N MAIN ST STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84663-4016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-358-4463
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2017

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: 1041C0700X , with the licence number:  10380399-3506 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10380399-3506 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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