1033269139 NPI number — DR. VYMAGDA CHICO NOLLA PSY. D

Table of content: DR. VYMAGDA CHICO NOLLA PSY. D (NPI 1033269139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033269139 NPI number — DR. VYMAGDA CHICO NOLLA PSY. D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHICO NOLLA
Provider First Name:
VYMAGDA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY. D
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:
1033269139
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:
543 AVE JOSE CEDENO
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00612-3935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-879-1121
Provider Business Mailing Address Fax Number:
787-879-1121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
543 AVE JOSE CEDENO
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612-3935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-879-1121
Provider Business Practice Location Address Fax Number:
787-879-1121
Provider Enumeration Date:
01/11/2007

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: 103TC0700X , with the licence number:  2238 , 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: 56791CH . This is a "TRIPLE SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 56791CH . This is a "TRIPLE SSS OPTIMO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2687 . This is a "APS T- REFORMA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2646 . This is a "HUMANA APS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PS-1006 . This is a "PALIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 528111 . This is a "MCS (PAE) (FHC)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 528111 . This is a "PMC (FHC)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 528111 . This is a "TRIPLE SSS FEDERAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: P844 . This is a "IMC FIRTS MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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