1144384256 NPI number — ROSA M. HEREDIA CASTILLO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144384256 NPI number — ROSA M. HEREDIA CASTILLO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSA M. HEREDIA CASTILLO
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:
1144384256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367331
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-7331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-722-0341
Provider Business Mailing Address Fax Number:
787-722-0341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 AVE DE LA CONSTITUCION
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00901-2298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-722-0341
Provider Business Practice Location Address Fax Number:
787-722-0341
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEREDIA
Authorized Official First Name:
ROSA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-722-0341

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  768 , 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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