1205076247 NPI number — DR. JANICE CRESPO - SALGADO M.D.

Table of content: DR. JANICE CRESPO - SALGADO M.D. (NPI 1205076247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205076247 NPI number — DR. JANICE CRESPO - SALGADO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRESPO - SALGADO
Provider First Name:
JANICE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1205076247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29134
Provider Second Line Business Mailing Address:
NEFROLOGIA PEDIATRICA RCM
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00929-0134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-758-7908
Provider Business Mailing Address Fax Number:
787-751-1808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CLINICA DE LA ESCUELA DE MEDICINA
Provider Second Line Business Practice Location Address:
REPARTO METROPOLITANO SHOPPING AVE AMERICO MIRANDA
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-7908
Provider Business Practice Location Address Fax Number:
787-751-1508
Provider Enumeration Date:
03/04/2009

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: 208000000X , with the licence number:  18250 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0210X , with the licence number: 18250 , 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)