1336462621 NPI number — ERIK CANCEL MOUNIER CRNA

Table of content: ERIK CANCEL MOUNIER CRNA (NPI 1336462621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336462621 NPI number — ERIK CANCEL MOUNIER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANCEL MOUNIER
Provider First Name:
ERIK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1336462621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3573
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:
00984-3573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-998-4957
Provider Business Mailing Address Fax Number:
787-998-4958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE PONCE DE LEON # 728
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-998-4957
Provider Business Practice Location Address Fax Number:
787-998-4958
Provider Enumeration Date:
03/01/2010

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: 367500000X , with the licence number:  1533 , 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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