1225152499 NPI number — MISS MAYRA MILAGROS VILA OLIVIERI BSN

Table of content: MISS MAYRA MILAGROS VILA OLIVIERI BSN (NPI 1225152499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225152499 NPI number — MISS MAYRA MILAGROS VILA OLIVIERI BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILA OLIVIERI
Provider First Name:
MAYRA
Provider Middle Name:
MILAGROS
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BSN
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:
1225152499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POBOX 1144
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLALBA
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00766
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
787-847-8113
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO PEDIATRICO
Provider Second Line Business Practice Location Address:
917 TITO CASTRO AVE
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PUERTO RICO
Provider Business Practice Location Address Postal Code:
00731
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
787-842-5884
Provider Business Practice Location Address Fax Number:
787-842-5802
Provider Enumeration Date:
03/16/2007

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: 163W00000X , with the licence number:  14273 , 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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