1093073074 NPI number — EDUARDO GALVAN FARIAS CSFA

Table of content: EDUARDO GALVAN FARIAS CSFA (NPI 1093073074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093073074 NPI number — EDUARDO GALVAN FARIAS CSFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARIAS
Provider First Name:
EDUARDO
Provider Middle Name:
GALVAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CSFA
Provider Gender Code:
M

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:
1093073074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6951 RAINTREE GRV
Provider Second Line Business Mailing Address:
LOT 2
Provider Business Mailing Address City Name:
ELMENDORF
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78112-7900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-787-9552
Provider Business Mailing Address Fax Number:
210-635-9551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6951 RAINTREE GRV
Provider Second Line Business Practice Location Address:
LOT 2
Provider Business Practice Location Address City Name:
ELMENDORF
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78112-7900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-787-9552
Provider Business Practice Location Address Fax Number:
210-635-9279
Provider Enumeration Date:
04/27/2012

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: 246ZC0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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