1003884032 NPI number — VYLSA E MARRERO SANCHEZ AUD

Table of content: VYLSA E MARRERO SANCHEZ AUD (NPI 1003884032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003884032 NPI number — VYLSA E MARRERO SANCHEZ AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARRERO SANCHEZ
Provider First Name:
VYLSA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
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:
1003884032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3469
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00970-3469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-790-2130
Provider Business Mailing Address Fax Number:
787-778-7439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
652 AVE SAN PATRICIO
Provider Second Line Business Practice Location Address:
SUMMIT HILLS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00920-4509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-792-0635
Provider Business Practice Location Address Fax Number:
787-792-0635
Provider Enumeration Date:
03/08/2006

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: 231H00000X , with the licence number:  00524 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231HA2400X , with the licence number: 00524 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231HA2500X , with the licence number: 00524 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 00524 , 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: 998189 . This is a "MEDICARE MUCHO MAS-MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9650041 . This is a "HUMANA HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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