Provider Demographics
NPI:1821599812
Name:AIMIENOHOR, REUBEN E
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:E
Last Name:AIMIENOHOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 WILBER CT APT B
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-8022
Mailing Address - Country:US
Mailing Address - Phone:504-287-1021
Mailing Address - Fax:
Practice Address - Street 1:1021 WILBER CT APT B
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-8022
Practice Address - Country:US
Practice Address - Phone:504-287-1021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-24
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver