1083951966 NPI number — MIAA INC

Table of content: (NPI 1083951966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083951966 NPI number — MIAA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIAA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1083951966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE BRAU # 44
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CABO ROJO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 100 KM 5.8
Provider Second Line Business Practice Location Address:
BO. MIRADERO
Provider Business Practice Location Address City Name:
CABO ROJO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-910-7910
Provider Business Practice Location Address Fax Number:
939-910-7911
Provider Enumeration Date:
01/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CINTRON
Authorized Official First Name:
IVELISSE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/RPH/I/C
Authorized Official Telephone Number:
939-910-7910

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 14F3077 , 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: 4028379 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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