1356449185 NPI number — DR. EMILIA DEL C CARDONA RIVERA DMD

Table of content: DR. EMILIA DEL C CARDONA RIVERA DMD (NPI 1356449185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356449185 NPI number — DR. EMILIA DEL C CARDONA RIVERA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDONA RIVERA
Provider First Name:
EMILIA
Provider Middle Name:
DEL C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARDONA
Provider Other First Name:
EMILIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1356449185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
218 DR FERNANDEZ ST
Provider Second Line Business Mailing Address:
P-2
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-755-7170
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
218 DR FERNANDEZ ST
Provider Second Line Business Practice Location Address:
P-2
Provider Business Practice Location Address City Name:
TRUJILLO ALTO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-755-7170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006

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: 122300000X , with the licence number:  1116 , 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: 041555 . This is a "CRUZ AZUL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41790 . This is a "SSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9760008 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4077 . This is a "FIRST MEDICAL HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 206480 . This is a "PREFERRED HEALTH UTI" identifier . This identifiers is of the category "OTHER".