1366636482 NPI number — MRS. GLADYSIRIS CARRASQUILLO MT

Table of content: MRS. GLADYSIRIS CARRASQUILLO MT (NPI 1366636482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366636482 NPI number — MRS. GLADYSIRIS CARRASQUILLO MT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRASQUILLO
Provider First Name:
GLADYSIRIS
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MT
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:
1366636482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 CALLE CATALINA MORALES
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
YABUCOA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00767-3305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-266-3300
Provider Business Mailing Address Fax Number:
787-266-3500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 MANSIONES DEL CARIBE AC-11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791-5206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-453-5989
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2007

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: 246QM0706X , with the licence number:  6204 , 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