1821157496 NPI number — MISS ROXANNE DIONISIO PORTUGAL OTRL

Table of content: MISS ROXANNE DIONISIO PORTUGAL OTRL (NPI 1821157496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821157496 NPI number — MISS ROXANNE DIONISIO PORTUGAL OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTUGAL
Provider First Name:
ROXANNE
Provider Middle Name:
DIONISIO
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
OTRL
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:
1821157496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2601 WESTVIEW DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-434-6886
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 3RD STREET
Provider Second Line Business Practice Location Address:
LINCOLN MANOR CARE CENTER
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-645-6942
Provider Business Practice Location Address Fax Number:
916-645-6942
Provider Enumeration Date:
12/08/2006

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: 225X00000X , with the licence number:  OT3279 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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