1003978636 NPI number — DR. ANNABELLE ITZEL PEREZ ROSARIO M.D

Table of content: DR. ANNABELLE ITZEL PEREZ ROSARIO M.D (NPI 1003978636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003978636 NPI number — DR. ANNABELLE ITZEL PEREZ ROSARIO M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ ROSARIO
Provider First Name:
ANNABELLE
Provider Middle Name:
ITZEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PEREZ ROSARIO
Provider Other First Name:
ANNABELLE
Provider Other Middle Name:
ITZEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003978636
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:
P.O BOX 141012
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614-1012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-454-1187
Provider Business Mailing Address Fax Number:
787-878-0462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE SAN JOSE
Provider Second Line Business Practice Location Address:
6
Provider Business Practice Location Address City Name:
LARES
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-454-1187
Provider Business Practice Location Address Fax Number:
787-878-0462
Provider Enumeration Date:
12/13/2006

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: 146D00000X , with the licence number:  16433 , 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)





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