1396942553 NPI number — JANET IVELISSE INFANTE 4172347

Table of content: JANET IVELISSE INFANTE 4172347 (NPI 1396942553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396942553 NPI number — JANET IVELISSE INFANTE 4172347

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INFANTE
Provider First Name:
JANET
Provider Middle Name:
IVELISSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
4172347
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:
1396942553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 CALLE CORDOVA
Provider Second Line Business Mailing Address:
URB. PUERTO NUEVO
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00920-5122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-235-9975
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 AVE JESUS T PINERO
Provider Second Line Business Practice Location Address:
URB. PUERTO NUEVO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-1819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-782-6129
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2007

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: 183700000X , 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)





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