1962698290 NPI number — IWONA CIBA DPM PLLC

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 1962698290 NPI number — IWONA CIBA DPM PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IWONA CIBA DPM PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1962698290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9211 WEST RD
Provider Second Line Business Mailing Address:
SUITE 143-105
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77064-8633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-395-9966
Provider Business Mailing Address Fax Number:
281-599-8596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 S FRY RD
Provider Second Line Business Practice Location Address:
SUITE 285
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77450-2256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-395-9966
Provider Business Practice Location Address Fax Number:
281-599-8596
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CIBA
Authorized Official First Name:
IWONA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-395-9966

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1427 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0000X , with the licence number: 1427 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: 1427 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213EP1101X , with the licence number: 1427 , 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)

  • Identifier: 018589401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00445E . This is a "MEDICARE PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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