1629540240 NPI number — ROSA V COLON TS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629540240 NPI number — ROSA V COLON TS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLON
Provider First Name:
ROSA
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
TS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLON PARRILLA
Provider Other First Name:
ROSA
Provider Other Middle Name:
VIVIANA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1629540240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB SANTA CRUZ
Provider Second Line Business Mailing Address:
B7 CALLE SANTA CRUZ
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961-6902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-780-9196
Provider Business Mailing Address Fax Number:
787-625-6124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB SANTA CRUZ
Provider Second Line Business Practice Location Address:
B7 CALLE SANTA CRUZ
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-6902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-780-9196
Provider Business Practice Location Address Fax Number:
787-625-6124
Provider Enumeration Date:
12/20/2018

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: 1041C0700X , with the licence number:  9507 , 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: 9507 . This is a "JUNTA DE LICENCIAMIENTO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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