1912180035 NPI number — BEATRIZ MARIA RODRIGUEZ GAZTAMBIDE MD

Table of content: BEATRIZ MARIA RODRIGUEZ GAZTAMBIDE MD (NPI 1912180035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912180035 NPI number — BEATRIZ MARIA RODRIGUEZ GAZTAMBIDE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ GAZTAMBIDE
Provider First Name:
BEATRIZ
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODRIGUEZ
Provider Other First Name:
BEATRIZ
Provider Other Middle Name:
MARIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1912180035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10005
Provider Second Line Business Mailing Address:
ELM HEALTH GROUP, LLC
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35631-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-768-9509
Provider Business Mailing Address Fax Number:
256-768-9715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 MARENGO ST
Provider Second Line Business Practice Location Address:
ELM HEALTH GROUP, LLC
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-768-9509
Provider Business Practice Location Address Fax Number:
256-768-9715
Provider Enumeration Date:
12/12/2007

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: 207Q00000X , with the licence number:  28474 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009913924 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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