1316042195 NPI number — ENID HAYDEE ACEVEDO QUINONES

Table of content: (NPI 1316042195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316042195 NPI number — ENID HAYDEE ACEVEDO QUINONES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENID HAYDEE ACEVEDO QUINONES
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:
LABORATORIO CLINICO GENESIS
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:
1316042195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1792
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARES
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00669-1792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-897-1636
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 111 KM 4.2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARES
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-897-1636
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUINONES
Authorized Official First Name:
ENID
Authorized Official Middle Name:
ACEVEDO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-897-1636

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  892 , 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: 800408 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA00612 . This is a "PALIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9996 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20024 . This is a "PREFERRED MEDICARE CHOISE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6690047 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 100150 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 011892 . This is a "GLOBAL HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 272535066 . This is a "ASOCIACION DE MAESTROS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31407 . This is a "TRIPLE SSS, INC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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