1043223506 NPI number — DR. JOSE JESUS LARRAURI RENTA M.D.

Table of content: DR. JOSE JESUS LARRAURI RENTA M.D. (NPI 1043223506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043223506 NPI number — DR. JOSE JESUS LARRAURI RENTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARRAURI RENTA
Provider First Name:
JOSE
Provider Middle Name:
JESUS
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:
1043223506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1883
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COAMO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00769-1883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-825-1224
Provider Business Mailing Address Fax Number:
787-825-0763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CALLE MARIO BRASCHI
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COAMO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00769-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-825-1224
Provider Business Practice Location Address Fax Number:
787-825-0763
Provider Enumeration Date:
08/15/2006

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: 208D00000X , with the licence number:  7382 , 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)





Copyright © 2007-2024 www.npivalidator.com