1770733149 NPI number — DR AMARYLIS ROSADO AND ASSOCIATES INC

Table of content: (NPI 1770733149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770733149 NPI number — DR AMARYLIS ROSADO AND ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR AMARYLIS ROSADO AND ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1770733149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
#387 CALLE VERSALLES
Provider Second Line Business Mailing Address:
URB. VILLAS REALES
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-802-2626
Provider Business Mailing Address Fax Number:
787-870-2781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 159 KM 15.4
Provider Second Line Business Practice Location Address:
LOCAL 308 PLAZA DEL CARMEN
Provider Business Practice Location Address City Name:
COROZAL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00783-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-802-2626
Provider Business Practice Location Address Fax Number:
787-870-2781
Provider Enumeration Date:
09/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROSADO RODRIGUEZ
Authorized Official First Name:
AMARYLIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-802-2626

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  15519 , 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: 15519 . This is a "LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com