1053526426 NPI number — DIANA LOPEZ

Table of content: (NPI 1053526426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053526426 NPI number — DIANA LOPEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIANA LOPEZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ISLA AMBULANCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053526426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVE CORAZON 1020
Provider Second Line Business Mailing Address:
PMB 7999 BUZON 181
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-530-2364
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
REPARTO FELICIANO # 3
Provider Second Line Business Practice Location Address:
APARTAMENTO 1 A
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-530-2364
Provider Business Practice Location Address Fax Number:
787-259-3292
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-530-2364

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  P1122 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TC AMB 446 . This is a "COMISION SERVICIO PUBLICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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