1699747691 NPI number — DR. LIDIA R GARIB GARCIA M.D.

Table of content: DR. LIDIA R GARIB GARCIA M.D. (NPI 1699747691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699747691 NPI number — DR. LIDIA R GARIB GARCIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARIB GARCIA
Provider First Name:
LIDIA
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1699747691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAJARDO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00738-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-860-1300
Provider Business Mailing Address Fax Number:
787-863-8300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 AVE GENERAL VALERO STE 408
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738-3992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-860-1300
Provider Business Practice Location Address Fax Number:
787-863-8300
Provider Enumeration Date:
02/03/2006

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: 208100000X , with the licence number:  8157 , 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: 7380006 . This is a "HUMANA HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: P00152916 . This is a "PALMETTO GBA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2-8157 . This is a "CIGNA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3481 . This is a "FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6605733612 . This is a "VA ADMINISTRATION" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2501791 . This is a "A.C.A.A." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 29459 . This is a "S.S.S." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 358239100 . This is a "O.W.C.P." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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