1528118312 NPI number — ANA L GUADALUPE SANTIAGO

Table of content: (NPI 1528118312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528118312 NPI number — ANA L GUADALUPE SANTIAGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANA L GUADALUPE SANTIAGO
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:
ODESSA MEDICAL TRASNPORT
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:
1528118312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 836
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYAMA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00785-0836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-466-3337
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB VILLA UNIVERSITARIA
Provider Second Line Business Practice Location Address:
CALLE LAFAYETTE 75
Provider Business Practice Location Address City Name:
GUAYAMA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-466-3337
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
ANA
Authorized Official Middle Name:
GUADALUPE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-466-3337

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  TC 433 , 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: TC433 . This is a "AMBULANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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