1104018654 NPI number — DR. CESAR H TRABANCO MD

Table of content: DR. CESAR H TRABANCO MD (NPI 1104018654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104018654 NPI number — DR. CESAR H TRABANCO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRABANCO
Provider First Name:
CESAR
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1104018654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10578
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00732-0578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-841-7168
Provider Business Mailing Address Fax Number:
787-840-1552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1006 PARRA MEDICAL INSTITUTE 2225 PONCE BY PASS
Provider Second Line Business Practice Location Address:
SUITE 1006
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-840-8686
Provider Business Practice Location Address Fax Number:
787-840-1552
Provider Enumeration Date:
08/17/2007

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: 207RE0101X , with the licence number:  7904 , 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: 81371 . This is a "MEDICARE & SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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