1033252358 NPI number — MRS. DEBORAH ABRIL MEDINA MASTER D.

Table of content: MRS. DEBORAH ABRIL MEDINA MASTER D. (NPI 1033252358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033252358 NPI number — MRS. DEBORAH ABRIL MEDINA MASTER D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDINA
Provider First Name:
DEBORAH
Provider Middle Name:
ABRIL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MASTER D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLARTE
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
ABRIL
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MASTER D,
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1033252358
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:
1312 FELIX ALDARONDO AVE.
Provider Second Line Business Mailing Address:
PMB 487
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-872-1717
Provider Business Mailing Address Fax Number:
787-872-1717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. #2 EDIFICIO PROFESSIONAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-872-1717
Provider Business Practice Location Address Fax Number:
787-872-1717
Provider Enumeration Date:
02/15/2007

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: 103T00000X , with the licence number:  2018 , 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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