1922048263 NPI number — DR. IVETTE PRATTS M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922048263 NPI number — DR. IVETTE PRATTS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRATTS
Provider First Name:
IVETTE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRATTS-PONCE DE LEON
Provider Other First Name:
SELENIA
Provider Other Middle Name:
IVETTE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1922048263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3103 AVE. ISLA VERDE
Provider Second Line Business Mailing Address:
APT. 504
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00979-4943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-403-9699
Provider Business Mailing Address Fax Number:
787-762-3561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3103 AVE. ISLA VERDE
Provider Second Line Business Practice Location Address:
APT. 504
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00979-4943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-403-9899
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2006

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: 208100000X , with the licence number:  4035 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 4035 , 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)