1962527135 NPI number — MISS APRIL BOLTIADOR REYES RPT

Table of content: MISS APRIL BOLTIADOR REYES RPT (NPI 1962527135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962527135 NPI number — MISS APRIL BOLTIADOR REYES RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES
Provider First Name:
APRIL
Provider Middle Name:
BOLTIADOR
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1962527135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1640 BROOKSHIRE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32904-6666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-704-6625
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7201 GREENBORO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32904-1698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-727-0990
Provider Business Practice Location Address Fax Number:
321-724-5289
Provider Enumeration Date:
03/20/2007

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: 225100000X , with the licence number:  PT23123 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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