1770577454 NPI number — DR. JOSE E PEREYO DIAZ M.D.

Table of content: DR. JOSE E PEREYO DIAZ M.D. (NPI 1770577454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770577454 NPI number — DR. JOSE E PEREYO DIAZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREYO DIAZ
Provider First Name:
JOSE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1770577454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9432
Provider Second Line Business Mailing Address:
BAYAMON BRANCH
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00960-6092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-787-8060
Provider Business Mailing Address Fax Number:
787-786-4870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIF. DR. ARTURO CADILLA
Provider Second Line Business Practice Location Address:
PASEO SAN PABLO #100 SUITE 207
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-787-8060
Provider Business Practice Location Address Fax Number:
787-786-4870
Provider Enumeration Date:
09/08/2005

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: 207RC0000X , with the licence number:  13705 , 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)