1366500746 NPI number — MILDRED DEL C ALGARIN AVILES

Table of content: (NPI 1366500746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366500746 NPI number — MILDRED DEL C ALGARIN AVILES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILDRED DEL C ALGARIN AVILES
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:
1366500746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 455
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOROVIS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-862-0500
Provider Business Mailing Address Fax Number:
787-862-0400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE DEL CARMEN #20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOROVIS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-862-0500
Provider Business Practice Location Address Fax Number:
787-862-0400
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALGARIN
Authorized Official First Name:
MILDRED
Authorized Official Middle Name:
DEL C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-862-0500

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  3181 , 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: 31041 . This is a "TRIPLE-S PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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