1093000846 NPI number — RAFAEL A GUTIERREZ R.PH.

Table of content: RAFAEL A GUTIERREZ R.PH. (NPI 1093000846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093000846 NPI number — RAFAEL A GUTIERREZ R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTIERREZ
Provider First Name:
RAFAEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
Provider Gender Code:
M

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:
1093000846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CARR #2 KM 129.7
Provider Second Line Business Mailing Address:
INT CARR 111 BO. VICTORIA
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00605-4007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-882-8044
Provider Business Mailing Address Fax Number:
787-882-0655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DBA: WALGREENS 00177 CARR 2 KM 129.7
Provider Second Line Business Practice Location Address:
INT CARR 111 BO. VICTORIA
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00605-4005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-882-8044
Provider Business Practice Location Address Fax Number:
787-882-0655
Provider Enumeration Date:
06/09/2011

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: 183500000X , with the licence number:  4015 , 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)