1578668943 NPI number — YAMILKA DAMARIS GODINEAUX MANFREDY MD MEDICO GENERALIST

Table of content: YAMILKA DAMARIS GODINEAUX MANFREDY MD MEDICO GENERALIST (NPI 1578668943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578668943 NPI number — YAMILKA DAMARIS GODINEAUX MANFREDY MD MEDICO GENERALIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GODINEAUX MANFREDY
Provider First Name:
YAMILKA
Provider Middle Name:
DAMARIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD MEDICO GENERALIST
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:
1578668943
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:
HC # 1 BOX 3562
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ISABEL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00757-9704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-299-8887
Provider Business Mailing Address Fax Number:
787-266-0127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VISION 2000 COMMERCE PLAZA SUITE301-305
Provider Second Line Business Practice Location Address:
PEDRO AFBIZU CAMPOS URB. COSTA AZUL
Provider Business Practice Location Address City Name:
GUAYAMA-
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00785-1920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-864-4300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2006

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: 208D00000X , with the licence number:  16136 , 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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