1215910823 NPI number — MAGALY BRACERO PEREZ M.D.

Table of content: MAGALY BRACERO PEREZ M.D. (NPI 1215910823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215910823 NPI number — MAGALY BRACERO PEREZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRACERO PEREZ
Provider First Name:
MAGALY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1215910823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 882
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CABO ROJO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00623-0882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-851-6407
Provider Business Mailing Address Fax Number:
787-851-6407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 CALLE MUNOZ RIVERA
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CABO ROJO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00623-3538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-851-6407
Provider Business Practice Location Address Fax Number:
787-851-6407
Provider Enumeration Date:
11/29/2005

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: 208D00000X , with the licence number:  14805 , 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: 14805 . This is a "SSBV" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: A499 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6230123 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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