1629051388 NPI number — CARMEN M BERRIOS RN

Table of content: CARMEN M BERRIOS RN (NPI 1629051388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629051388 NPI number — CARMEN M BERRIOS RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRIOS
Provider First Name:
CARMEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1629051388
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 73
Provider Second Line Business Mailing Address:
BOX 6190
Provider Business Mailing Address City Name:
CAYEY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00736-9804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-263-7144
Provider Business Mailing Address Fax Number:
717-764-9904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVENIDOS 65 INFANTERIC
Provider Second Line Business Practice Location Address:
KM 1 HM 3.4, BARRIO SABANA ILANA
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-767-7676
Provider Business Practice Location Address Fax Number:
787-764-9904
Provider Enumeration Date:
11/26/2005

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: 163WG0000X , with the licence number:  6176 , 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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