Provider Demographics
NPI:1598248205
Name:ESSEX, ALMATRIGA VLADZETTA
Entity Type:Individual
Prefix:
First Name:ALMATRIGA
Middle Name:VLADZETTA
Last Name:ESSEX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-5205
Mailing Address - Country:US
Mailing Address - Phone:205-239-8210
Mailing Address - Fax:205-891-8274
Practice Address - Street 1:3330 MAIN AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-5205
Practice Address - Country:US
Practice Address - Phone:205-239-8210
Practice Address - Fax:205-891-8274
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-09
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL94185335E00000X
AL328936174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty