1275752149 NPI number — MR. LEXTER ROSARIO SANJURJO I PHD

Table of content: MR. LEXTER ROSARIO SANJURJO I PHD (NPI 1275752149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275752149 NPI number — MR. LEXTER ROSARIO SANJURJO I PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSARIO SANJURJO
Provider First Name:
LEXTER
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
I
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSARIO
Provider Other First Name:
LEXTER
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1275752149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 CALLE HERNANDEZ
Provider Second Line Business Mailing Address:
COND. MIRAMAR TOWERS APT 12-C
Provider Business Mailing Address City Name:
SAN JAUN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-310-2604
Provider Business Mailing Address Fax Number:
787-876-2003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 188-JNT 187 LOIZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOIZA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-876-2042
Provider Business Practice Location Address Fax Number:
787-876-2003
Provider Enumeration Date:
04/25/2007

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: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 2363 , 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: 2363 . This is a "PSYCHOLOGIST PROFESSIONAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2363 . This is a "PSYCHOLOGY" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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