Free National NPI Number Registry
Deactivated
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NPI Number Detailed Information
Provider Information:
| Name: | Deactivated |
| Gender: | |
| Provider License Number If Given: |
NPI Information:
| NPI: | 1619970803 |
| Entity Type (Individual or Organization): |
0-org |
| Enumeration Date: | 1/0/1900 |
| Last Update Date: | 1/0/1900 |
Provider Business Mailing Address:
| Address: | , |
| Phone Number: | |
| Fax Number: |
Provider Business Practice Location Address:
| Address: | , |
| Phone Number: | |
| Fax Number: |
Provider Taxonomy:
| Primary: | 0 |
| Secondary (if any): | |
| State: |
