1356873517 NPI number — SONIA A. GONZALEZ ECHEVARRIA

Table of content: (NPI 1356873517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356873517 NPI number — SONIA A. GONZALEZ ECHEVARRIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SONIA A. GONZALEZ ECHEVARRIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1356873517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
A49 CALLE MARGINAL
Provider Second Line Business Mailing Address:
URB. BARALT
Provider Business Mailing Address City Name:
FAJARDO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00738-3759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-801-2966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
A49 CALLE MARGINAL
Provider Second Line Business Practice Location Address:
URB. BARALT
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738-3759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-801-2966
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
SONIA
Authorized Official Middle Name:
AIXA
Authorized Official Title or Position:
OCUPPATIONAL THERAPIST
Authorized Official Telephone Number:
787-801-2966

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , with the licence number:  589 , 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: 589 . This is a "MEDICAL INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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