1073859971 NPI number — THE MILLENNIUM INSTITUTE

Table of content: MEGHANA TANGUTURI REDDY MD (NPI 1043915325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073859971 NPI number — THE MILLENNIUM INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MILLENNIUM INSTITUTE
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:
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:
1073859971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CALLE COSME REPARTO SAN LUCAS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-5955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-708-0138
Provider Business Mailing Address Fax Number:
787-720-6072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CALLE COSME REPARTO SAN LUCAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-5955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-708-0138
Provider Business Practice Location Address Fax Number:
787-720-6072
Provider Enumeration Date:
12/20/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VILAR
Authorized Official First Name:
RAFAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-708-0138

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  LIC 44 , 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: LIC. NUM 44 . This is a "MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LIC. NO 44 . This is a "MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".