1699747345 NPI number — DR. MAYRA MILAGROS LEGRAND FLORES D.M.D.

Table of content: DR. MAYRA MILAGROS LEGRAND FLORES D.M.D. (NPI 1699747345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699747345 NPI number — DR. MAYRA MILAGROS LEGRAND FLORES D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEGRAND FLORES
Provider First Name:
MAYRA
Provider Middle Name:
MILAGROS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
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:
1699747345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
B18 CALLE SAN BARTOLOME
Provider Second Line Business Mailing Address:
URB. NOTRE DAME
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725-3924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-778-6349
Provider Business Mailing Address Fax Number:
787-780-5592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. TENIENTE N. MARTINEZ L17
Provider Second Line Business Practice Location Address:
URB. ALTURAS DE FLAMBOYAN
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-6565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-778-6349
Provider Business Practice Location Address Fax Number:
787-780-5592
Provider Enumeration Date:
02/06/2006

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: 1223G0001X , with the licence number:  2419 , 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: 42377 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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