NPI |
1548879323 |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Entity Type Code |
1 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Last Name Legal Name |
LOPEZ |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider First Name |
JACQUELINE |
The city name in the location address of the provider being identified. |
Provider Credential Text |
RBT |
The State code in the location of the provider
being identified. |
Provider First Line Business Practice Location Address |
4910 AIRPORT AVE STE F |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address City Name |
ROSENBERG |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
TX |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
774715759 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
2812391428 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider Business Practice Location Address Fax Number |
2812390828 |
The first name of the authorized official. |
Provider Enumeration Date |
7/28/2020 |
The title or position of the authorized official. |
Last Update Date |
7/28/2020 |
The 10-position telephone number of the authorized official. |
Provider Gender Code |
F |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Taxonomy Code 1 |
106S00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
RBT-18-73266 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
TX |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
7/28/2020 |
|