1164433736 NPI number — VANESSA PEREZ

Table of content: (NPI 1164433736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164433736 NPI number — VANESSA PEREZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VANESSA PEREZ
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:
1164433736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMUY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00627-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-421-6977
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 149 KM 18.0 BO PESAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CIALES
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-871-2305
Provider Business Practice Location Address Fax Number:
787-871-2541
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
VANESSA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
787-871-2305

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 18-F-2387 , 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: 2087091 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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