1194708941 NPI number — GLADYS TERESA FERNANDEZ RN

Table of content: GLADYS TERESA FERNANDEZ RN (NPI 1194708941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194708941 NPI number — GLADYS TERESA FERNANDEZ RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ
Provider First Name:
GLADYS
Provider Middle Name:
TERESA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1194708941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 2510
Provider Second Line Business Mailing Address:
PO BOX 231
Provider Business Mailing Address City Name:
TRUSILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00977-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-760-9001
Provider Business Mailing Address Fax Number:
787-764-9904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVEWIDA 65 ZU FANTERIA K134
Provider Second Line Business Practice Location Address:
BARRIO SABANA LLANO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-767-7676
Provider Business Practice Location Address Fax Number:
787-764-9904
Provider Enumeration Date:
11/25/2005

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: 163WG0000X , with the licence number:  16561 , 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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