Individual provider Active NPI

Maria Laura Reategui Via Y Rada

  • Student in an Organized Health Care Education/Training Program
  • Indianapolis, IN
National Provider Identifier
1417691577
Registry record updated Apr 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1130 W Michigan St # Fh400
Indianapolis, IN 46202-5209
Phone
(317) 278-1258
Fax
(317) 274-8285
NPI assigned
Apr 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1130 W Michigan St # Fh400
Indianapolis, IN 46202-5209

Mailing address

1130 W Michigan St # Fh400
Indianapolis, IN 46202-5209
Phone (317) 278-1258

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220629000467 IN Order and Referring Only - OtolaryngologyPractitioner - Otolaryngology 9335529940

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1417691577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 W MICHIGAN ST # FH400",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025209",
            "telephone_number": "317-278-1258",
            "fax_number": "317-274-8285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 W MICHIGAN ST # FH400",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025209",
            "telephone_number": "317-278-1258",
            "fax_number": "317-274-8285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REATEGUI VIA Y RADA",
        "first_name": "MARIA LAURA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-25",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.