1891278362 NPI number — CLAUDIA IRENE THIBEAULT

Table of content: CLAUDIA IRENE THIBEAULT (NPI 1891278362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891278362 NPI number — CLAUDIA IRENE THIBEAULT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIBEAULT
Provider First Name:
CLAUDIA
Provider Middle Name:
IRENE
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:
GATLIN, FREEMAN , VASQUEZ, DARNELL
Provider Other First Name:
CLAUDIA
Provider Other Middle Name:
IRENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891278362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
413 ORCHARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT NECHES
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77651-3187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-744-4067
Provider Business Mailing Address Fax Number:
713-799-2202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3315 MARQUART ST STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77027-6027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-799-2200
Provider Business Practice Location Address Fax Number:
713-799-2202
Provider Enumeration Date:
09/11/2018

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: 164X00000X , with the licence number:  203309 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com