1316259740 NPI number — MR. RAYMOND MARISCAL JR.

Table of content: MR. RAYMOND MARISCAL JR. (NPI 1316259740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316259740 NPI number — MR. RAYMOND MARISCAL JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARISCAL
Provider First Name:
RAYMOND
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
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:
1316259740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1845 US HIGHWAY 93 S
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-5721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-752-6798
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1845 US HIGHWAY 93 S
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901-5721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-752-6798
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2010

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: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 173 . This is a "STATE OF MONTANA, DEPARTMENT OF LABOR AND INDUSTRY" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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