1386691764 NPI number — ELSIE M WISCOVICH-TERUEL MD

Table of content: ELSIE M WISCOVICH-TERUEL MD (NPI 1386691764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386691764 NPI number — ELSIE M WISCOVICH-TERUEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISCOVICH-TERUEL
Provider First Name:
ELSIE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1386691764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VILLA DE TORRIMAR
Provider Second Line Business Mailing Address:
410 REINA ISABEL
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969-3342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-731-9391
Provider Business Mailing Address Fax Number:
787-287-0974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CONDOMINIO PICO CENTER LOCAL 101
Provider Second Line Business Practice Location Address:
CONDADO 120
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-977-3897
Provider Business Practice Location Address Fax Number:
787-722-5305
Provider Enumeration Date:
05/30/2006

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: 2084P0800X , with the licence number:  6665 , 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)





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