1891766507 NPI number — MARITZA E GRAJALES SOTO

Table of content: (NPI 1891766507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891766507 NPI number — MARITZA E GRAJALES SOTO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARITZA E GRAJALES SOTO
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:
LAB CLINICO LA MILAGROSA
Provider Other Organization Name Type Code:
3
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:
1891766507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3386
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00984-3386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-769-8349
Provider Business Mailing Address Fax Number:
787-257-8490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE ROBERTO CLEMENTE CALLE 11 BLOQUE 33 # 17
Provider Second Line Business Practice Location Address:
URB VILLA CAROLINA
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00985-5436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-769-8349
Provider Business Practice Location Address Fax Number:
787-257-8490
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAJALES SOTO
Authorized Official First Name:
MARITZA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-667-1902

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  266 , 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: 30387 . This is a "MEDICARE OPTIMO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 30387CL . This is a "SSS & SSS OPTIMO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ITIN . This is a "CIGNA & CIGNA EXCLUSIVE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 40D0658056 . This is a "CLIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ITIN . This is a "FIRST PLUS MEDICARE ADVAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 50370 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6300078 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ITIN . This is a "MAPFRE & MAPFRE MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20425 . This is a "PREFFERED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8392 . This is a "FIRST MEDICAL- I.M.C." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ITIN . This is a "MCS REFORMA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ITIN . This is a "COSVI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 011266 . This is a "GLOBAL HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400643 . This is a "UTI- PREFFERED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ITIN . This is a "MCS & MCS CLASSICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA0066 . This is a "PALIC- PANAMERICAN LIFE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1049 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 800210 . This is a "MEDICARE Y MUCHO MAS-MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ITIN . This is a "OPTION HEALTHCARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com