1235312505 NPI number — DRA. DAISY VAZQUEZ DUBEAU OB-GYN CSP

Table of content: MR. STEPHEN WILLIAM O'CURRAN QMHA (NPI 1134415748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235312505 NPI number — DRA. DAISY VAZQUEZ DUBEAU OB-GYN CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRA. DAISY VAZQUEZ DUBEAU OB-GYN CSP
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:
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:
1235312505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 195567
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:
00919-5567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-766-1920
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
576 CALLE CESAR GONZALEZ STE 401
Provider Second Line Business Practice Location Address:
DORAL BANK CENTER
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-3769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-766-1920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONTALVO
Authorized Official First Name:
GRISELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
787-306-5800

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  10973 , 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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