1831633155 NPI number — LISET DE LA CARIDAD DEL VALLE GARCIA

Table of content: LISET DE LA CARIDAD DEL VALLE GARCIA (NPI 1831633155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831633155 NPI number — LISET DE LA CARIDAD DEL VALLE GARCIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEL VALLE GARCIA
Provider First Name:
LISET
Provider Middle Name:
DE LA CARIDAD
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:
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:
1831633155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10885 NW 50TH ST
Provider Second Line Business Mailing Address:
APT 203
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33178-3976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-474-7513
Provider Business Mailing Address Fax Number:
305-901-1797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10885 NW 50TH ST
Provider Second Line Business Practice Location Address:
APT 203
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33178-3976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-474-7513
Provider Business Practice Location Address Fax Number:
305-901-1797
Provider Enumeration Date:
12/05/2016

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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