1568341584 NPI number — MR. VICTOR RICARDO URIBE CORMEJO

Table of content: MR. VICTOR RICARDO URIBE CORMEJO (NPI 1568341584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568341584 NPI number — MR. VICTOR RICARDO URIBE CORMEJO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
URIBE CORMEJO
Provider First Name:
VICTOR
Provider Middle Name:
RICARDO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1568341584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1195 LA PAZ AVENUE, LA PERLA, CALLAO
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
LIMA
Provider Business Mailing Address Postal Code:
07016
Provider Business Mailing Address Country Code:
PE
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:
1195 LA PAZ AVENUE, LA PERLA, CALLAO
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
LIMA
Provider Business Practice Location Address Postal Code:
07016
Provider Business Practice Location Address Country Code:
PE
Provider Business Practice Location Address Telephone Number:
519-793-0247
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2025

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: 171R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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