1871756056 NPI number — EDGARDO R RICHIEZ TEM

Table of content: EDGARDO R RICHIEZ TEM (NPI 1871756056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871756056 NPI number — EDGARDO R RICHIEZ TEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHIEZ
Provider First Name:
EDGARDO
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
TEM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SERVICE
Provider Other First Name:
RICHIEZ
Provider Other Middle Name:
AMBULANCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1871756056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAUCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00698-3020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-856-3713
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BARRIADA LLUBERAS EL PARALELO CARR 376 KM 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAUCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-856-3713
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2008

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: 146L00000X , with the licence number:  P690 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: TCAMB104 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)