1851568794 NPI number — MRS. VANESSA HERNANDEZ MEDICAL TECHNOLOGY

Table of content: MRS. VANESSA HERNANDEZ MEDICAL TECHNOLOGY (NPI 1851568794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851568794 NPI number — MRS. VANESSA HERNANDEZ MEDICAL TECHNOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
VANESSA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MEDICAL TECHNOLOGY
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:
1851568794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 47
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-0047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-818-1325
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 420 KM 0.4
Provider Second Line Business Practice Location Address:
BO VOLADORAS
Provider Business Practice Location Address City Name:
MOCA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-818-1325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2008

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: 246QL0900X , with the licence number:  1013 , 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: 31410 . This is a "TRIPLE SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660706058 . This is a "INTERNATIONAL MEDICAL CARD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660706058 . This is a "MEDICAL CARD SYSTEM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660706058 . This is a "BELLA VISTA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31410 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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