1316063092 NPI number — DR. VIVIAN GREEN ECHAVARRIA LND, MSC, PHD

Table of content: DR. VIVIAN GREEN ECHAVARRIA LND, MSC, PHD (NPI 1316063092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316063092 NPI number — DR. VIVIAN GREEN ECHAVARRIA LND, MSC, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN ECHAVARRIA
Provider First Name:
VIVIAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LND, MSC, PHD
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:
1316063092
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:
827 SERENIDAD STREET
Provider Second Line Business Mailing Address:
URB. PARAISO DE COAMO
Provider Business Mailing Address City Name:
COAMO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-840-2575
Provider Business Mailing Address Fax Number:
787-259-0661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ANA D. PERRZ MARCHADO STREET URB. INDUSTRIAL REPARADA,
Provider Second Line Business Practice Location Address:
PUBLIC HEALTH PROGRAM, PONCE SCHOOL OF MEDICINE
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00732-7004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-840-2575
Provider Business Practice Location Address Fax Number:
787-259-0661
Provider Enumeration Date:
03/22/2007

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: 133V00000X , with the licence number:  892 , 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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