Healthcare Provider Details

I. General information

NPI: 1619009990
Provider Name (Legal Business Name): NORMA RECIO-PASIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 NORTH 64TH STREET
BELLEVILLE IL
62223-3808
US

IV. Provider business mailing address

P.O. BOX 822344
PHILADELPHIA PA
19182-2344
US

V. Phone/Fax

Practice location:
  • Phone: 908-653-9399
  • Fax: 908-653-9305
Mailing address:
  • Phone: 314-991-0985
  • Fax: 908-653-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35071
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: