1447427240 NPI number — MR. IVAN LOPERENA PROPIETARY

Table of content: MR. IVAN LOPERENA PROPIETARY (NPI 1447427240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447427240 NPI number — MR. IVAN LOPERENA PROPIETARY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPERENA
Provider First Name:
IVAN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PROPIETARY
Provider Gender Code:
M

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:
1447427240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 URB CRISTAL
Provider Second Line Business Mailing Address:
BO CORRALES
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00603-6306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-882-5915
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 URB CRISTAL
Provider Second Line Business Practice Location Address:
BO CORRALES
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603-6306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-882-5915
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2008

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: 171M00000X , with the licence number:  1094 , 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: 20458 . This is a "PMC MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660561350 . This is a "MCS REFORMA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660561350 . This is a "HUMANA GOLD PLUS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660561350 . This is a "MEDICAL CARD SYSTEM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660561350 . This is a "TRICARE STANDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31489 . This is a "MEDICARE SELECTO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660561350 . This is a "HUMANA GOLD CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660561350 . This is a "COSVI MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31489 . This is a "TRIPLE SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660561350 . This is a "MEDICARE EXCELL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660561350 . This is a "MCS CLASSICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660561350 . This is a "TRICARE PRIME" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660561350 . This is a "INTERNATIONAL MEDICAL CARD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1053383216 . This is a "SAL;UD DORADA MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31489 . This is a "MEDICARE OPTIMO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31489 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6030092 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660561350 . This is a "FIRST PLUS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20526 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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