1326145848 NPI number — SANTIAGO R VARELA

Table of content: JEREMY FELICE CAMPANO DO (NPI 1063158608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326145848 NPI number — SANTIAGO R VARELA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANTIAGO R VARELA
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:
Provider Other Organization Name Type Code:
6
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:
1326145848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 144
Provider Second Line Business Mailing Address:
CALLE SAN ANTONIO #17
Provider Business Mailing Address City Name:
ANASCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00610-0144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-826-4400
Provider Business Mailing Address Fax Number:
787-826-6738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE SAN ANTONIO #17
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANASCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-826-4120
Provider Business Practice Location Address Fax Number:
787-826-6738
Provider Enumeration Date:
09/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VARELA
Authorized Official First Name:
SANTIAGO
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-826-4120

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  07F1287 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 07F1287 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: 07F1287 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 1314290002 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 07-F-1287 , 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)