1376661793 NPI number — VALENI MASTECTOMY WOMENS HEALTH

Table of content: (NPI 1316590243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376661793 NPI number — VALENI MASTECTOMY WOMENS HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALENI MASTECTOMY WOMENS HEALTH
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:
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:
1376661793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COLORADO ST. 1631
Provider Second Line Business Mailing Address:
URB. SAN GERARDO
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-798-7023
Provider Business Mailing Address Fax Number:
508-682-0917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SANTA ROSA MALL
Provider Second Line Business Practice Location Address:
SUITE 202 B
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-6710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-798-7023
Provider Business Practice Location Address Fax Number:
508-682-0917
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LICEAGA
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-798-7023

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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