1427541606 NPI number — LCDA.MORAIMA GARCIA VERGARA

Table of content: (NPI 1427541606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427541606 NPI number — LCDA.MORAIMA GARCIA VERGARA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LCDA.MORAIMA GARCIA VERGARA
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:
LCDA.MORAIMA GARCIA VERGARA
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:
1427541606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 CALLE LUIS MUNOZ RIVERA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YABUCOA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00767-3103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 CALLE VICTORIA STE 17 LEGACY MEDICAL CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791-3337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-318-2041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
MORAIMA
Authorized Official Middle Name:
Authorized Official Title or Position:
NUTRITIONIST/DIETITIAN
Authorized Official Telephone Number:
787-318-2041

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)