1144408527 NPI number — DR. NADJA IVETTE CRESPO PHD

Table of content: DR. NADJA IVETTE CRESPO PHD (NPI 1144408527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144408527 NPI number — DR. NADJA IVETTE CRESPO PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRESPO
Provider First Name:
NADJA
Provider Middle Name:
IVETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1144408527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DD14 CALLE 215
Provider Second Line Business Mailing Address:
URB VALLE ARRIBA HEIGHTS
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00983-3708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-647-3294
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLQ 35 #21 AV SANCHEZ CASTANO
Provider Second Line Business Practice Location Address:
URB. VILLA CAROLINA GRUPO MEDICO CAROLINA LLC
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00985-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-752-1979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2008

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: 103TC0700X , with the licence number:  2963 , 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: 2963 . This is a "PSYCHOLOGIST LICENCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2112567 . This is a "DRIVER'S LICENCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".