1578646147 NPI number — ENID HORTENSIA TROCHE DMD

Table of content: ENID HORTENSIA TROCHE DMD (NPI 1578646147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578646147 NPI number — ENID HORTENSIA TROCHE DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROCHE
Provider First Name:
ENID
Provider Middle Name:
HORTENSIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1578646147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE BOQUERON #28
Provider Second Line Business Mailing Address:
VILLAS DE LA PLAYA
Provider Business Mailing Address City Name:
VEGA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00693
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-807-7671
Provider Business Mailing Address Fax Number:
787-807-7671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE JOSE JULIAN ACOSTA #42
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VEGA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-807-7671
Provider Business Practice Location Address Fax Number:
787-807-7671
Provider Enumeration Date:
10/24/2006

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: 1223G0001X , with the licence number:  2359 , 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)