1649816646 NPI number — LYAN MARIE PORRATA PHARMD

Table of content: LYAN MARIE PORRATA PHARMD (NPI 1649816646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649816646 NPI number — LYAN MARIE PORRATA PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORRATA
Provider First Name:
LYAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PORRATA
Provider Other First Name:
LYAN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DRA. LYAN PORRATA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1649816646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB LA ALHAMBRA CALLE GRANADA 2102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-232-3907
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1730 PR-506, COTO LAUREL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-840-8801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/25/2019

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: 183500000X , with the licence number:  006735 , 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)