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1659633550 NPI number — MARY ANGELA CANCINO GALLAGHER OTR/L

NPI Number: 1659633550
Health Care Provider/Practitioner: MARY ANGELA CANCINO GALLAGHER OTR/L

Information about “1659633550” NPI (MARY ANGELA CANCINO GALLAGHER OTR/L) exists in 1659633550 in HTML format HTML  |  1659633550 in plain Text format TXT  |  1659633550 in PDF (Portable Document Format) PDF  |  1659633550 in an XML format XML  formats.

NPI Number : 1659633550 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659633550",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CANCINO GALLAGHER",
    "FirstName": "MARY ANGELA",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GALLAGHER",
    "OtherFirstName": "MARY ANGELA",
    "OtherMiddleName": "CANCINO",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "OTR/L",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "304 N RICHARDSON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROSWELL",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "88201-4639",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "575-578-0069",
    "MailingAddressFaxNumber": "575-578-0124",
    "FirstLinePracticeLocationAddress": "304 N RICHARDSON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROSWELL",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "88201-4639",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "575-578-0069",
    "PracticeLocationAddressFaxNumber": "575-578-0124",
    "EnumerationDate": "06/15/2012",
    "LastUpdateDate": "06/15/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QX0100X",
        "TaxonomyName": "Occupational Medicine Clinic/Center",
        "LicenseNumber": "2927",
        "LicenseNumberStateCode": "NM",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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