1508991076 NPI number — DR. MAYRA LETICIA LLADO ORTEGA D.M.D

Table of content: DR. MAYRA LETICIA LLADO ORTEGA D.M.D (NPI 1508991076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508991076 NPI number — DR. MAYRA LETICIA LLADO ORTEGA D.M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LLADO ORTEGA
Provider First Name:
MAYRA
Provider Middle Name:
LETICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D
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:
1508991076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE RAFAEL LAMAR 374-A
Provider Second Line Business Mailing Address:
EXT ROOSEVELT
Provider Business Mailing Address City Name:
HATO REY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-767-7471
Provider Business Mailing Address Fax Number:
787-765-9643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
374 CALLE RAFAEL LAMAR
Provider Second Line Business Practice Location Address:
EXT ROOSEVELT
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-767-7471
Provider Business Practice Location Address Fax Number:
787-765-9643
Provider Enumeration Date:
02/23/2007

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: 1223P0700X , with the licence number:  2148 , 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)