1356121404 NPI number — FLORENCIA KARINA MIRANDA CHUMPITAZ NP

Table of content: FLORENCIA KARINA MIRANDA CHUMPITAZ NP (NPI 1356121404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356121404 NPI number — FLORENCIA KARINA MIRANDA CHUMPITAZ NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRANDA CHUMPITAZ
Provider First Name:
FLORENCIA
Provider Middle Name:
KARINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

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:
1356121404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 672
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COBB
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95426-0672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-513-6002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
359 LAKEPORT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEPORT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95453-5412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-513-6002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2023

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: 363LP2300X , with the licence number:  95027548 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 95027548 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com