1063517563 NPI number — MARTA BRITO-HERNANDEZ RPT

Table of content: MARTA BRITO-HERNANDEZ RPT (NPI 1063517563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063517563 NPI number — MARTA BRITO-HERNANDEZ RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRITO-HERNANDEZ
Provider First Name:
MARTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1063517563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 CALLE MONTREAL
Provider Second Line Business Mailing Address:
OLIMPIC VILLE
Provider Business Mailing Address City Name:
LAS PIEDRAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00771-9696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-644-5074
Provider Business Mailing Address Fax Number:
787-258-3212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 CALLE GAUTIER BENITEZ
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-5527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-258-3275
Provider Business Practice Location Address Fax Number:
787-258-3212
Provider Enumeration Date:
09/13/2006

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: 225100000X , with the licence number:  1141 , 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: 1141 . This is a "RPT LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com