1346344058 NPI number — MISS JOANNE RIOS CORUJO PT

Table of content: MISS JOANNE RIOS CORUJO PT (NPI 1346344058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346344058 NPI number — MISS JOANNE RIOS CORUJO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIOS CORUJO
Provider First Name:
JOANNE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1346344058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 192445
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:
00919-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-788-0833
Provider Business Mailing Address Fax Number:
787-788-0833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE ISIDRA RODRIGUEZ
Provider Second Line Business Practice Location Address:
6
Provider Business Practice Location Address City Name:
CATANO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-788-0833
Provider Business Practice Location Address Fax Number:
787-788-0833
Provider Enumeration Date:
09/12/2006

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: 225100000X , with the licence number:  627 , 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: 0823 . This is a "FIRST MEDICAL" identifier . This identifiers is of the category "OTHER".




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