1255652574 NPI number — DR. YVETTE MARIE BONUS SANTIAGO MD

Table of content: DR. YVETTE MARIE BONUS SANTIAGO MD (NPI 1255652574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255652574 NPI number — DR. YVETTE MARIE BONUS SANTIAGO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTIAGO
Provider First Name:
YVETTE MARIE
Provider Middle Name:
BONUS
Provider Name Prefix Text:
DR.
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:
1255652574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 BROOKLINE AVE
Provider Second Line Business Mailing Address:
APT 253
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215-3938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-682-6365
Provider Business Mailing Address Fax Number:
617-573-5525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 CHARLES ST
Provider Second Line Business Practice Location Address:
1ST FLOOR EYEPLASTICS
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-573-5548
Provider Business Practice Location Address Fax Number:
617-573-5525
Provider Enumeration Date:
06/21/2010

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: 207W00000X , with the licence number:  243393 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com