1205143971 NPI number — MRS. MARYKARMEN VERGELI ROJAS

Table of content: MRS. MARYKARMEN VERGELI ROJAS (NPI 1205143971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205143971 NPI number — MRS. MARYKARMEN VERGELI ROJAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERGELI ROJAS
Provider First Name:
MARYKARMEN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1205143971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
513 CALLE WITO MORALES
Provider Second Line Business Mailing Address:
ESTANCIAS DEL GOLF CLUB
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00730-0531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-247-6386
Provider Business Mailing Address Fax Number:
787-290-5002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
513 CALLE WITO MORALES
Provider Second Line Business Practice Location Address:
ESTANCIAS DEL GOLF CLUB
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00730-0531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-247-6386
Provider Business Practice Location Address Fax Number:
787-290-5002
Provider Enumeration Date:
09/01/2010

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: 104100000X , with the licence number:  11975 , 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)