1992868442 NPI number — DR. KIRSTEN ELIZABETH DELAMBO PHD

Table of content: DR. KIRSTEN ELIZABETH DELAMBO PHD (NPI 1992868442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992868442 NPI number — DR. KIRSTEN ELIZABETH DELAMBO PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELAMBO
Provider First Name:
KIRSTEN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHRIVER
Provider Other First Name:
KIRSTEN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992868442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WILFORD HALL AMBULATORY SURGICAL CENTER
Provider Second Line Business Mailing Address:
1100 WILFORD HALL LOOP, BLDG 4554
Provider Business Mailing Address City Name:
JBSA-LACKLAND AFB
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78236-9908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-292-6371
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 WILFORD HALL LOOP # 4554
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JBSA LACKLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78236-5638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-292-6371
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2006

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: 103T00000X , with the licence number:  6141 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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