1164671970 NPI number — XAMAYTA L NEGRONI-BALASQUIDE MD

Table of content: XAMAYTA L NEGRONI-BALASQUIDE MD (NPI 1164671970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164671970 NPI number — XAMAYTA L NEGRONI-BALASQUIDE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEGRONI-BALASQUIDE
Provider First Name:
XAMAYTA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1164671970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
346 VALLE DE TORRIMAR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966-8707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-222-1048
Provider Business Mailing Address Fax Number:
787-474-1370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BAYAMON MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE 910
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-474-8282
Provider Business Practice Location Address Fax Number:
787-474-1370
Provider Enumeration Date:
09/17/2008

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: 2080P0210X , with the licence number:  18164 , 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: 013694300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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