1356651830 NPI number — MISS IDRIS ANGELLICE SANTIAGO MARTINEZ MSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356651830 NPI number — MISS IDRIS ANGELLICE SANTIAGO MARTINEZ MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTIAGO MARTINEZ
Provider First Name:
IDRIS
Provider Middle Name:
ANGELLICE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTINEZ
Provider Other First Name:
IDRIS
Provider Other Middle Name:
SANTIAGO
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1356651830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC03BOX11447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENUELAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00624-9513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-590-4375
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HC03BOX11447
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENUELAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00624-9513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-590-4375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2010

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: 1041C0700X , with the licence number:  10002 , 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)





Copyright © 2007-2025 www.npivalidator.com