1558576991 NPI number — MS. MADELISA MONROIG-LOPEZ M.S.

Table of content: MS. MADELISA MONROIG-LOPEZ M.S. (NPI 1558576991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558576991 NPI number — MS. MADELISA MONROIG-LOPEZ M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONROIG-LOPEZ
Provider First Name:
MADELISA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
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:
1558576991
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:
AF9 CALLE TORREON
Provider Second Line Business Mailing Address:
VENUS GARDENS
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-4721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-760-9481
Provider Business Mailing Address Fax Number:
787-763-3681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 GUARIONEX
Provider Second Line Business Practice Location Address:
LOCAL 2
Provider Business Practice Location Address City Name:
HATO REY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-767-3655
Provider Business Practice Location Address Fax Number:
787-763-3681
Provider Enumeration Date:
05/11/2007

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: 103T00000X , with the licence number:  2566 , 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: 2566 . This is a "PROFESSIONAL LICENCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com