1669518445 NPI number — MARISOL COLLAZO ORTIZ INC

Table of content: (NPI 1669518445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669518445 NPI number — MARISOL COLLAZO ORTIZ INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARISOL COLLAZO ORTIZ INC
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:
DBA LABORATORIO CLINICO CENTRO MEDICINA ESPECIALIZADA
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:
1669518445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 CALLE BARCELO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CIDRA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00739-3446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-739-5525
Provider Business Mailing Address Fax Number:
787-739-2054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 CALLE BARCELO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CIDRA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00739-3446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-739-5525
Provider Business Practice Location Address Fax Number:
787-739-2054
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLLAZO
Authorized Official First Name:
MARISOL
Authorized Official Middle Name:
Authorized Official Title or Position:
LAB DIRECTOR
Authorized Official Telephone Number:
787-739-5525

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  807 , 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: 15843 . This is a "AMPR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20213 . This is a "PREFERRED MEDICARE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6390009 . This is a "HUMANA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6390009 . This is a "HUMANA INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51539 . This is a "LACRUZ AZUL DE PUERTO RIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: LB00746 . This is a "UIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20463 . This is a "AMERICAN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6390009 . This is a "HUMANA REFORMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30778 . This is a "TRIPLE S" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0877 . This is a "INTERNATIONAL MEDICAL CAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400123 . This is a "PREFERRED HEALTH UTI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com