1871243238 NPI number — RIGAL CORALYS SERRANO TORRES

Table of content: RIGAL CORALYS SERRANO TORRES (NPI 1871243238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871243238 NPI number — RIGAL CORALYS SERRANO TORRES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SERRANO TORRES
Provider First Name:
RIGAL
Provider Middle Name:
CORALYS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SERRANO TORRES
Provider Other First Name:
RIGAL
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871243238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MIRADERO KM. 5.8, 108 RD, NO. 1886
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00682-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-932-4264
Provider Business Mailing Address Fax Number:
787-961-4562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MIRADERO KM. 5.8
Provider Second Line Business Practice Location Address:
108 RD. NO. 1886
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00682-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-932-4264
Provider Business Practice Location Address Fax Number:
787-961-4562
Provider Enumeration Date:
03/28/2022

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: 208D00000X , with the licence number:  23257 , 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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