1740393453 NPI number — VIDAL VAZQUEZ SANTANA M.D.

Table of content: KEVIN STUMPF (NPI 1073230587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740393453 NPI number — VIDAL VAZQUEZ SANTANA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZQUEZ SANTANA
Provider First Name:
VIDAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1740393453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363003
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:
00936-3003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-977-0707
Provider Business Mailing Address Fax Number:
787-977-0708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1519 PONCE DE LEON AVE. PDA.23
Provider Second Line Business Practice Location Address:
SUITE 1105 FIRST BANK BUILDING
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-977-0707
Provider Business Practice Location Address Fax Number:
787-977-0708
Provider Enumeration Date:
08/16/2006

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: 207RC0000X , with the licence number:  8049 , 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: 4508049 . This is a "UIA PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1688 . This is a "PMC PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 992650 . This is a "MMM PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 066905 . This is a "CRUZ AZUL PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3156 . This is a "AHP PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 80019 . This is a "TRIPLE S PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: N121 . This is a "IMC PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 220192 . This is a "PREFERRED HEALTH PROV ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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