1265913396 NPI number — ALEXANDRA M CANABAL MONTALVO

Table of content: ALEXANDRA M CANABAL MONTALVO (NPI 1265913396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265913396 NPI number — ALEXANDRA M CANABAL MONTALVO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANABAL MONTALVO
Provider First Name:
ALEXANDRA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1265913396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVE CASA LINDA 1 SUITE 101
Provider Second Line Business Mailing Address:
CENTRO PREVENTIVO GUAYNABO
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00959-8998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-789-1996
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
D-4 REINA VICTORIA
Provider Second Line Business Practice Location Address:
QUINTAS REALES
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-459-0097
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2018

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: 208D00000X , with the licence number:  22501 , 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)





Copyright © 2007-2025 www.npivalidator.com