1285246306 NPI number — DR. BLANCA NAUDIN PH.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285246306 NPI number — DR. BLANCA NAUDIN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAUDIN
Provider First Name:
BLANCA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NAUDIN
Provider Other First Name:
BLANCA
Provider Other Middle Name:
MORENO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1285246306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8649 NORTHRIDGE LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78045-7517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-535-8044
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 N ED CAREY DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-8343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-230-1210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2020

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: 390200000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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