1609800143 NPI number — DR. RAFAEL FELIZ LEBREAULT M.D.

Table of content: THOMAS PARNELL MD (NPI 1538621214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609800143 NPI number — DR. RAFAEL FELIZ LEBREAULT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELIZ LEBREAULT
Provider First Name:
RAFAEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1609800143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4615
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VEGA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00694-4615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-855-1385
Provider Business Mailing Address Fax Number:
787-807-8912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. NUM. 2 KM 39.5
Provider Second Line Business Practice Location Address:
SUITE 110
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:
787-855-1385
Provider Business Practice Location Address Fax Number:
787-807-8912
Provider Enumeration Date:
07/10/2006

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: 207R00000X , with the licence number:  4823 , 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)

  • Identifier: 100197 . This is a "MEDICARE MUCHO MAS ID#" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 212176 . This is a "UTI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 25874 . This is a "SSS OF PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 25874 . This is a "MEDICARE OPTIMO ID#" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4823 . This is a "COSVI PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1661 . This is a "PEFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4823 . This is a "IMC PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6430019 . This is a "HUMANA PORVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 063664 . This is a "CRUZ AZUL DE PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 29825 . This is a "AAMPR PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3387 . This is a "AMERICAN HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4304823 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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