1922202712 NPI number — MRS. MARIA DEL ROSARIO AMAYA PA-C

Table of content: MRS. MARIA DEL ROSARIO AMAYA PA-C (NPI 1922202712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922202712 NPI number — MRS. MARIA DEL ROSARIO AMAYA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMAYA
Provider First Name:
MARIA
Provider Middle Name:
DEL ROSARIO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1922202712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4651 CHARLOTTE PARK DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28217-1956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-936-5577
Provider Business Mailing Address Fax Number:
704-323-7931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 ROUND ROCK AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78681-4514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-779-9452
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2007

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: 363A00000X , with the licence number:  PA02870 , 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)





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