1750828612 NPI number — MADELINE GONZALEZ TECHNICIAN PHARMACIS

Table of content: MADELINE GONZALEZ TECHNICIAN PHARMACIS (NPI 1750828612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750828612 NPI number — MADELINE GONZALEZ TECHNICIAN PHARMACIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
MADELINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
TECHNICIAN PHARMACIS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALEZ
Provider Other First Name:
MADELINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
TECHNICIAN PHARMACIS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1750828612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 6 BOX 68059
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00603-9898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-219-4473
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 462 KM 1.2
Provider Second Line Business Practice Location Address:
CAIMITAL ALTO
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-219-4473
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2017

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: 183700000X , with the licence number:  5762 , 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: 4065933 . This is a "DRIVER LIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 5762 . This is a "PHARMACYST TECHNICIN #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".