1972798494 NPI number — REGINA D DEIPARINE NLMT

Table of content: REGINA D DEIPARINE NLMT (NPI 1972798494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972798494 NPI number — REGINA D DEIPARINE NLMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEIPARINE
Provider First Name:
REGINA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NLMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEIPARINE
Provider Other First Name:
REGINA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NLMT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1972798494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 PINE TREE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORMOND BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32174-2634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-547-3910
Provider Business Mailing Address Fax Number:
386-615-4951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
533 N NOVA RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-4447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-615-4990
Provider Business Practice Location Address Fax Number:
386-615-4951
Provider Enumeration Date:
09/07/2007

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: 174400000X , with the licence number:  45105 , 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)

  • Identifier: 45105 . This is a "FLORIDA LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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