1174645899 NPI number — MRS. MADELINE MANGUAL LIC 002465

Table of content: MRS. MADELINE MANGUAL LIC 002465 (NPI 1174645899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174645899 NPI number — MRS. MADELINE MANGUAL LIC 002465

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANGUAL
Provider First Name:
MADELINE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LIC 002465
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:
1174645899
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:
CALLE ORQUIDEA #300
Provider Second Line Business Mailing Address:
CIVDAD APERDIN
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-276-6162
Provider Business Mailing Address Fax Number:
787-876-0558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE AUTONOMIA #71
Provider Second Line Business Practice Location Address:
FARMACIA SAN ANTONIO
Provider Business Practice Location Address City Name:
CANOVANAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-876-2705
Provider Business Practice Location Address Fax Number:
787-876-0558
Provider Enumeration Date:
04/04/2007

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: 183500000X , with the licence number:  002465 , 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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