1104020429 NPI number — NICOLAS LOPEZ DIAZ

Table of content: NICOLAS LOPEZ DIAZ (NPI 1104020429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104020429 NPI number — NICOLAS LOPEZ DIAZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ DIAZ
Provider First Name:
NICOLAS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SERVICE
Provider Other First Name:
ACTIVE
Provider Other Middle Name:
AMBULANCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1104020429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 AVE. PENSILVANNIA APARTADO # 406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-448-0911
Provider Business Mailing Address Fax Number:
787-824-7738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB. LA ARBOLEDA 349 CALLE 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-448-0911
Provider Business Practice Location Address Fax Number:
787-824-7738
Provider Enumeration Date:
06/12/2007

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: 146N00000X , with the licence number:  2003476 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: TCAMB457 , 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)