1336660281 NPI number — ALEXANDRA ESTRADA ROSA RD

Table of content: ALEXANDRA ESTRADA ROSA RD (NPI 1336660281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336660281 NPI number — ALEXANDRA ESTRADA ROSA RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTRADA ROSA
Provider First Name:
ALEXANDRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD
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:
1336660281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB MARINA BAHIA
Provider Second Line Business Mailing Address:
MF-15, PLAZA 32
Provider Business Mailing Address City Name:
CATANO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-637-6627
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1492 AVE PONCE DE LEON
Provider Second Line Business Practice Location Address:
EDIF. CENTRO EUROPA 713
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-4024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-723-5017
Provider Business Practice Location Address Fax Number:
787-723-5015
Provider Enumeration Date:
06/30/2017

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:  001960 , 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: 1960 . This is a "PR HEALTH DEPARTMENT" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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