1124430467 NPI number — DRA VALENIE RIVERA ROIG PSC

Table of content: DORIT DORCAS GAEDTKE MD (NPI 1740254069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124430467 NPI number — DRA VALENIE RIVERA ROIG PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRA VALENIE RIVERA ROIG PSC
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:
1124430467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 AVE TITO CASTRO STE 804
Provider Second Line Business Mailing Address:
TORRE MEDICA SAN LUCAS
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716-4725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-648-8115
Provider Business Mailing Address Fax Number:
787-651-1498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 AVE TITO CASTRO STE 804
Provider Second Line Business Practice Location Address:
TORRE MEDICA SAN LUCAS
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716-4725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-648-8115
Provider Business Practice Location Address Fax Number:
787-651-1498
Provider Enumeration Date:
05/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ROIG
Authorized Official First Name:
VALENIE
Authorized Official Middle Name:
RIVERA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-648-8115

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  14868 , 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: 337401 . This is a "CERTIFICADO DE REGISTRO DEPARTAMENTO DE ESTADO DE PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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