1992731103 NPI number — MRS. YVONNE HEREDIA-KOSTER ATC

Table of content: DR. JONATHAN SAMUEL FRIEDMAN DMD (NPI 1376617456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992731103 NPI number — MRS. YVONNE HEREDIA-KOSTER ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEREDIA-KOSTER
Provider First Name:
YVONNE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEREDIA
Provider Other First Name:
YVONNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992731103
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:
6724 DESERT CANYON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912-7604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-845-3152
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 PERSHING DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79903-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-562-8525
Provider Business Practice Location Address Fax Number:
915-566-3889
Provider Enumeration Date:
06/23/2006

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: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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