1154530558 NPI number — MRS. SARA LUZINES GONZALEZ MSSLP

Table of content: MRS. SARA LUZINES GONZALEZ MSSLP (NPI 1154530558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154530558 NPI number — MRS. SARA LUZINES GONZALEZ MSSLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
SARA
Provider Middle Name:
LUZINES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSSLP
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:
1154530558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5004
Provider Second Line Business Mailing Address:
PMB 193
Provider Business Mailing Address City Name:
YAUCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00698-5004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-267-1226
Provider Business Mailing Address Fax Number:
787-267-1226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 CALLE 25 DE JULIO
Provider Second Line Business Practice Location Address:
ESQUINA PASAREL
Provider Business Practice Location Address City Name:
YAUCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00698-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-267-1226
Provider Business Practice Location Address Fax Number:
787-267-1226
Provider Enumeration Date:
05/22/2007

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: 235Z00000X , with the licence number:  593 , 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)





Copyright © 2007-2024 www.npivalidator.com