1700875143 NPI number — DR. BERNARDO ANTONIO DEPAZ REYES MD

Table of content: DR. BERNARDO ANTONIO DEPAZ REYES MD (NPI 1700875143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700875143 NPI number — DR. BERNARDO ANTONIO DEPAZ REYES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEPAZ REYES
Provider First Name:
BERNARDO
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1700875143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 270187
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:
00928-2987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-768-2335
Provider Business Mailing Address Fax Number:
787-769-3308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GP3 AVE CAMPO RICO
Provider Second Line Business Practice Location Address:
COUNTRY CLUB
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00982-2677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-768-2335
Provider Business Practice Location Address Fax Number:
787-769-3308
Provider Enumeration Date:
10/18/2005

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: 207W00000X , with the licence number:  2931 , 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)





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