1316042195 NPI number — ENID HAYDEE ACEVEDO QUINONES

Table of content: MS. KELLY LEE CROSSLEY DPT (NPI 1114060688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316042195 NPI number — ENID HAYDEE ACEVEDO QUINONES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENID HAYDEE ACEVEDO QUINONES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LABORATORIO CLINICO GENESIS
Provider Other Organization Name Type Code:
3
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:
1316042195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1792
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARES
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00669-1792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-897-1636
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 111 KM 4.2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARES
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-897-1636
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUINONES
Authorized Official First Name:
ENID
Authorized Official Middle Name:
ACEVEDO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-897-1636

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  892 , 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: 800408 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA00612 . This is a "PALIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9996 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20024 . This is a "PREFERRED MEDICARE CHOISE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6690047 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 100150 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 011892 . This is a "GLOBAL HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 272535066 . This is a "ASOCIACION DE MAESTROS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31407 . This is a "TRIPLE SSS, INC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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