1164585873 NPI number — LYNETTE RIOS RODRIGUEZ RPT

Table of content: LYNETTE RIOS RODRIGUEZ RPT (NPI 1164585873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164585873 NPI number — LYNETTE RIOS RODRIGUEZ RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIOS RODRIGUEZ
Provider First Name:
LYNETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1164585873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE 5 BLOQUE C NUMERO 20
Provider Second Line Business Mailing Address:
ESTANCIAS DE SAN FERNANDO
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-637-4897
Provider Business Mailing Address Fax Number:
787-276-7030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4ES12 AVENIDA FRAGOSO
Provider Second Line Business Practice Location Address:
VILLA FONTANA
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-276-7006
Provider Business Practice Location Address Fax Number:
787-276-7030
Provider Enumeration Date:
12/18/2006

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: 225100000X , with the licence number:  1279 , 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)





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