=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598248205
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALMATRIGA VLADZETTA ESSEX
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2018
-----------------------------------------------------
Last Update Date | 03/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3330 MAIN AVE
-----------------------------------------------------
City | NORTHPORT
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35476-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-239-8210
-----------------------------------------------------
Fax | 205-891-8274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3330 MAIN AVE
-----------------------------------------------------
City | NORTHPORT
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35476-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-239-8210
-----------------------------------------------------
Fax | 205-891-8274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 94185
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------