1013131069 NPI number — MISS VANGIE GONZALEZ M.T

Table of content: MISS VANGIE GONZALEZ M.T (NPI 1013131069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013131069 NPI number — MISS VANGIE GONZALEZ M.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
VANGIE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.T
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:
1013131069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VILLA ALEGRIA 291
Provider Second Line Business Mailing Address:
TURQUESA
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-882-2107
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
V1 CALLE 16
Provider Second Line Business Practice Location Address:
URB. VILLA LOS SANTOS
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-879-1609
Provider Business Practice Location Address Fax Number:
787-880-3733
Provider Enumeration Date:
04/12/2007

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: 246QM0706X , with the licence number:  5716 , 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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