Provider Demographics
NPI:1356621957
Name:PROMOHISPANO 2 INC
Entity type:Organization
Organization Name:PROMOHISPANO 2 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-231-2222
Mailing Address - Street 1:4609 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64124-2927
Mailing Address - Country:US
Mailing Address - Phone:816-231-2222
Mailing Address - Fax:816-241-4214
Practice Address - Street 1:4609 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64124-2927
Practice Address - Country:US
Practice Address - Phone:816-231-2222
Practice Address - Fax:816-241-4214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier