1326019928 NPI number — WILFREDO REYES LABRADOR

Table of content: (NPI 1326019928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326019928 NPI number — WILFREDO REYES LABRADOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILFREDO REYES LABRADOR
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:
1326019928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3386
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00984-3386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-757-1040
Provider Business Mailing Address Fax Number:
787-757-1040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PISO 6, OFIC 312,
Provider Second Line Business Practice Location Address:
CAROLINA SHOPPING COURT
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-757-1040
Provider Business Practice Location Address Fax Number:
787-757-1040
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAJALES
Authorized Official First Name:
MARITZA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-667-1902

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  236 , 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: ITIN . This is a "MCS & MCS REFORMA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA0351 . This is a "PALIC-PANAMERICAN LIFE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 800219 . This is a "MEDICARE Y MUCHO MAS- MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20024 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 51652 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ITIN . This is a "MAPFRE & MAPFRE MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1100105 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 30955 . This is a "MEDICARE OPTIMO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 30955 . This is a "SSS & SSS REFORMA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8397 . This is a "FIRST MEDICAL- IMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ITIN . This is a "CIGNA & CIGNA EXCLUSIVE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20408 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6007449 . This is a "ACAA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ITIN . This is a "OPTION HEALTHCARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 11236 . This is a "GLOBAL HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400337 . This is a "UTI- PREFFERED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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