1205034717 NPI number — MISS MARIA R VARELA-ORTIZ LND

Table of content: MISS MARIA R VARELA-ORTIZ LND (NPI 1205034717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205034717 NPI number — MISS MARIA R VARELA-ORTIZ LND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARELA-ORTIZ
Provider First Name:
MARIA
Provider Middle Name:
R
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LND
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:
1205034717
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:
401 AVE AMERICO MIRANDA
Provider Second Line Business Mailing Address:
COOP LOS ROBLES APT 706-B
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00927-4632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-758-6972
Provider Business Mailing Address Fax Number:
787-758-6972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 CALLE JUAN P DUARTE
Provider Second Line Business Practice Location Address:
PRIMER PISO COND DUARTE
Provider Business Practice Location Address City Name:
HATO REY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-759-6909
Provider Business Practice Location Address Fax Number:
787-758-6972
Provider Enumeration Date:
07/05/2007

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: 133N00000X , with the licence number:  869 , 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: 6500090 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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