1922144609 NPI number — MARISOL CALLAZO ORTIZ INC

Table of content: (NPI 1922144609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922144609 NPI number — MARISOL CALLAZO ORTIZ INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARISOL CALLAZO 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:
LABORATORIO CLINICO MICROBIOLOGICO PUERTO RICO
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:
1922144609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAYEY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00737-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-738-7556
Provider Business Mailing Address Fax Number:
787-738-1515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVENIDA LUIS MUNOZ MARIN #11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-738-7556
Provider Business Practice Location Address Fax Number:
787-738-1515
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:
78773875556

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  746 , 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: 0877 . This is a "INTERNATIONAL MEDICAL CAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15843 . This is a "AMPR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20463 . This is a "AMERICAN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30646 . This is a "TRIPLE S" 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: 400123 . This is a "PREFERRED HEALTH UTI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6330044 . This is a "HUMANA REFORMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6330044 . This is a "HUMANA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: LB00746 . This is a "UIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051387 . This is a "LA CRUZ AZUL DE PUERTO RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6330044 . This is a "HUMANA INSURANCE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com