1114069507 NPI number — PROF. IVONNE ANGLERO RD, LND, MMSC

Table of content: PROF. IVONNE ANGLERO RD, LND, MMSC (NPI 1114069507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114069507 NPI number — PROF. IVONNE ANGLERO RD, LND, MMSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANGLERO
Provider First Name:
IVONNE
Provider Middle Name:
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
RD, LND, MMSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1114069507
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB PONCE DE LEON
Provider Second Line Business Mailing Address:
22 STREET #191
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969-4433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-756-8529
Provider Business Mailing Address Fax Number:
787-756-8529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
INGENIERO GALINDEZ STREET CPRS LOBBY
Provider Second Line Business Practice Location Address:
TERRENOS DE CENTRO MEDICO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00935-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-756-8529
Provider Business Practice Location Address Fax Number:
787-756-8529
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  00579 , 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)





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