1528208337 NPI number — DR. CORALEE PEREZ PEDROGO PH.D.

Table of content: DR. CORALEE PEREZ PEDROGO PH.D. (NPI 1528208337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528208337 NPI number — DR. CORALEE PEREZ PEDROGO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ PEDROGO
Provider First Name:
CORALEE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1528208337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. VILLA NEVAREZ STREET 10
Provider Second Line Business Mailing Address:
1020
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00927-0152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-299-4792
Provider Business Mailing Address Fax Number:
787-751-0772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CONDADO STREET NUMBER 607
Provider Second Line Business Practice Location Address:
COND. CONDADO OFFICE 401
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-299-4792
Provider Business Practice Location Address Fax Number:
787-725-5013
Provider Enumeration Date:
03/06/2009

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: 103TC0700X , with the licence number:  3283 , 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)





Copyright © 2007-2024 www.npivalidator.com