1104665637 NPI number — MISS GENESIS MARIE RAMOS SEGARRA LP

Table of content: MISS GENESIS MARIE RAMOS SEGARRA LP (NPI 1104665637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104665637 NPI number — MISS GENESIS MARIE RAMOS SEGARRA LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMOS SEGARRA
Provider First Name:
GENESIS
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LP
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:
1104665637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE SAN IGNACIO #502
Provider Second Line Business Mailing Address:
URB. SANTA RITA I
Provider Business Mailing Address City Name:
COTO LAUREL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00780-2277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-342-8162
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2984 AVE EMILIO FAGOT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-546-5315
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2024

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: 103TC1900X , with the licence number:  7846 , 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)





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