1598155756 NPI number — MOUMITA CHOUDHURY MS., CCC-A

Table of content: MOUMITA CHOUDHURY MS., CCC-A (NPI 1598155756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598155756 NPI number — MOUMITA CHOUDHURY MS., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOUDHURY
Provider First Name:
MOUMITA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS., CCC-A
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:
1598155756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3601 4TH ST
Provider Second Line Business Mailing Address:
# 2A300
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79430-6073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-674-0593
Provider Business Mailing Address Fax Number:
575-674-0599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 ARROWHEAD DR.
Provider Second Line Business Practice Location Address:
BLDG. 08
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88011-5129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-674-0593
Provider Business Practice Location Address Fax Number:
575-674-0599
Provider Enumeration Date:
01/27/2015

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: 231H00000X , with the licence number:  81138 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X , with the licence number: 5668 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: L3211 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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