1043484231 NPI number — MYRNA SANTIAGO CAMACHO

Table of content: MYRNA SANTIAGO CAMACHO (NPI 1043484231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043484231 NPI number — MYRNA SANTIAGO CAMACHO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTIAGO CAMACHO
Provider First Name:
MYRNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVILA
Provider Other First Name:
LABORATORIO CLINICO
Provider Other Middle Name:
HERMANAS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1043484231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51527
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00950-1527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-780-8000
Provider Business Mailing Address Fax Number:
787-740-7149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 AVE BETANCES URB HERMANAS DAVILA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-780-8000
Provider Business Practice Location Address Fax Number:
787-740-7149
Provider Enumeration Date:
04/17/2008

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: 291U00000X , with the licence number:  659 , 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: 30513 . This is a "TRIPLE-S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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