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DAIBELIZ TAMARA VEGA GONZALEZ MSPAS, PA-C, ATC
Complete NPI Record 1750796330
Physician Assistant in North Platte, NE

NPI Status: Active since June 23, 2014

Contact Information

611 W FRANCIS ST STE 200
NORTH PLATTE, NE
ZIP 69101
Phone: (308) 568-3500

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Provider Gender Code
  22. Healthcare Provider Taxonomy Code 1
  23. Provider License Number 1
  24. Provider License Number State Code 1
  25. Healthcare Provider Primary Taxonomy Switch 1
  26. Healthcare Provider Taxonomy Code 2
  27. Provider License Number 2
  28. Provider License Number State Code 2
  29. Healthcare Provider Primary Taxonomy Switch 2
  30. Is Sole Proprietor
  31. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1750796330. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1750796330
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: DAIBELIZ
The first name of the provider, if the provider is an individual.
Provider Middle Name: TAMARA
The middle name of the provider, if the provider is an individual.
Provider Credential Text: MSPAS, PA-C, ATC
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 611 W FRANCIS ST STE 200
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: NORTH PLATTE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NE
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 691010614
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 3085683500
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 611 W FRANCIS ST STE 200
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 Business Practice Location Address City Name: NORTH PLATTE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: NE
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 691010614
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: 3085683500
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 6/23/2014
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/31/2021
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 2255A2300X
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: 2000016608
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: FL
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: N
Healthcare Provider Taxonomy Code 2: 363A00000X
Provider License Number 2: PA.0006419
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Provider License Number State Code 2: CO
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Healthcare Provider Primary Taxonomy Switch 2: 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: 3/31/2021