1487773289 NPI number — DR. MINERVA N RODRIGUEZ PEREZ MD

Table of content: JEANNETTE WILLIAMS (NPI 1285895243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487773289 NPI number — DR. MINERVA N RODRIGUEZ PEREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ PEREZ
Provider First Name:
MINERVA
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1487773289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1696
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOQUERON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00622-1696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-450-2840
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO. SAN ANTONIO, CARR. 483, KM 0.9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEBRADILLAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-450-2840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2007

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: 207RI0200X , with the licence number:  16391 , 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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