1164407078 NPI number — DR. JULIO E DIEPPA MD

Table of content: DR. JULIO E DIEPPA MD (NPI 1164407078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164407078 NPI number — DR. JULIO E DIEPPA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIEPPA
Provider First Name:
JULIO
Provider Middle Name:
E
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:
1164407078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
F6 VIA BOGOTA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961-3087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-756-5685
Provider Business Mailing Address Fax Number:
787-763-7833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
271 DOMENECH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-756-5685
Provider Business Practice Location Address Fax Number:
787-763-7833
Provider Enumeration Date:
12/13/2005

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: 208100000X , with the licence number:  6503 , 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: 1276 . This is a "FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3506503 . This is a "PLAN SALUD UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2501082 . This is a "ACCA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2870 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 068130 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 601434 . This is a "MEDICARE MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 97835 . This is a "TRIPLE SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PE0255 . This is a "PALIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: HUMANA . This is a "6460004" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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