1699845602 NPI number — GLADYS E NEGRON M.D. PSC

Table of content: GLADYS E NEGRON M.D. PSC (NPI 1699845602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699845602 NPI number — GLADYS E NEGRON M.D. PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEGRON
Provider First Name:
GLADYS
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D. PSC
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:
1699845602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 CALLE MARLIN AZUL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VEGA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00693-3559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-202-1848
Provider Business Mailing Address Fax Number:
888-859-5656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARIBBEAN CINEMA SECOND FLOOR
Provider Second Line Business Practice Location Address:
#1 OFIC
Provider Business Practice Location Address City Name:
BARCELONETA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-382-5230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006

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: 207VX0000X , with the licence number:  A065789 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: 18436 , 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: 18436 . This is a "PUERTO RICO STAT MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".