1982921037 NPI number — MISS MARIA TERESA DEMAVIVAS APN

Table of content: MISS MARIA TERESA DEMAVIVAS APN (NPI 1982921037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982921037 NPI number — MISS MARIA TERESA DEMAVIVAS APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMAVIVAS
Provider First Name:
MARIA
Provider Middle Name:
TERESA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1982921037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 W CHARLESTON BLVD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89102-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-877-9511
Provider Business Mailing Address Fax Number:
702-877-6711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 W CHARLESTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89102-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-877-9511
Provider Business Practice Location Address Fax Number:
702-877-6711
Provider Enumeration Date:
04/29/2010

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: 363LF0000X , with the licence number:  APN001170 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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