1649659756 NPI number — PUERTO RICO VASCULAR ACCESS CENTER PSC

Table of content: RHAYNA DANNIELLE WALIZER MSW (NPI 1073961355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649659756 NPI number — PUERTO RICO VASCULAR ACCESS CENTER PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUERTO RICO VASCULAR ACCESS CENTER PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1649659756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 361275
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-1275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-758-3320
Provider Business Mailing Address Fax Number:
787-758-3358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE PONCE DE LEON PDA 37 1/2
Provider Second Line Business Practice Location Address:
HOSP AUXILIO MUTUO 1ST FL
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-3320
Provider Business Practice Location Address Fax Number:
787-758-3358
Provider Enumeration Date:
05/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-361-0012

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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