1881024487 NPI number — MR. FERDINAND RAYCO MADAYAG APRN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881024487 NPI number — MR. FERDINAND RAYCO MADAYAG APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADAYAG
Provider First Name:
FERDINAND
Provider Middle Name:
RAYCO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
M

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:
1881024487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3325 RESEARCH WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89706-7913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-888-6610
Provider Business Mailing Address Fax Number:
775-888-4904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 E FARM RD
Provider Second Line Business Practice Location Address:
HCR 69, BOX 401-V
Provider Business Practice Location Address City Name:
AMARGOSA VALLEY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89020-9795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-372-5432
Provider Business Practice Location Address Fax Number:
775-372-1303
Provider Enumeration Date:
11/18/2013

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: 363L00000X , with the licence number:  APRN001614 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1881024487 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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