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1073063053 NPI number — ELLIE EBREO LLC

NPI Number: 1073063053
Health Care Provider/Practitioner: ELLIE EBREO LLC

Information about “1073063053” NPI (ELLIE EBREO LLC) exists in 1073063053 in HTML format HTML  |  1073063053 in plain Text format TXT  |  1073063053 in PDF (Portable Document Format) PDF  |  1073063053 in an XML format XML  formats.

NPI Number : 1073063053 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073063053",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ELLIE EBREO LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2134 E GRIFFIN PKWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MISSION",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78572-3225",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "956-207-2433",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2134 E GRIFFIN PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MISSION",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78572-3225",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "956-207-2433",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/13/2016",
    "LastUpdateDate": "10/13/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "VILLAFRANCA",
    "AuthorizedOfficialFirstName": "EMIL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "956-802-6690",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2300X",
        "TaxonomyName": "Primary Care Clinic/Center",
        "LicenseNumber": "688312",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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