1760659387 NPI number — MRS. CHRISTINE SERRAN SARMIENTO PT

Table of content: MRS. CHRISTINE SERRAN SARMIENTO PT (NPI 1760659387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760659387 NPI number — MRS. CHRISTINE SERRAN SARMIENTO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARMIENTO
Provider First Name:
CHRISTINE
Provider Middle Name:
SERRAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1760659387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3290 NORTH RIDGE ROAD
Provider Second Line Business Mailing Address:
SUITE 290 EXECUTIVE CENTER 2
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-757-0885
Provider Business Mailing Address Fax Number:
410-750-0785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3290 NORTH RIDGE ROAD
Provider Second Line Business Practice Location Address:
SUITE 290 EXECUTIVE CENTER 2
Provider Business Practice Location Address City Name:
ELLICOTT CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-757-0885
Provider Business Practice Location Address Fax Number:
410-750-0785
Provider Enumeration Date:
05/13/2008

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: 225100000X , with the licence number:  15447 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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