1164607966 NPI number — ELDA L. SANTIAGO PEREZ

Table of content: RAQUEL BENNETT (NPI 1831405711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164607966 NPI number — ELDA L. SANTIAGO PEREZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELDA L. SANTIAGO PEREZ
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:
6
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:
1164607966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2191
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674-2191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-854-1546
Provider Business Mailing Address Fax Number:
787-633-1575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 670 KAROMA PLAZA
Provider Second Line Business Practice Location Address:
SUITE #12
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-854-1546
Provider Business Practice Location Address Fax Number:
787-633-1575
Provider Enumeration Date:
12/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO-PEREZ
Authorized Official First Name:
ELDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-854-1546

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  367 , 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: 84143SA , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com