1396753208 NPI number — MRS. RAYDA NANETTE HERNANDEZ-GUASCH MD

Table of content: MRS. RAYDA NANETTE HERNANDEZ-GUASCH MD (NPI 1396753208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396753208 NPI number — MRS. RAYDA NANETTE HERNANDEZ-GUASCH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ-GUASCH
Provider First Name:
RAYDA
Provider Middle Name:
NANETTE
Provider Name Prefix Text:
MRS.
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:
1396753208
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:
PMB 525
Provider Second Line Business Mailing Address:
#89 DE DIEGO AVE SUITE 105
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00927-5831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-269-2250
Provider Business Mailing Address Fax Number:
787-269-2295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SANTA CRUZ ST #64
Provider Second Line Business Practice Location Address:
GALERIA MEDICA SUITE 104
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-7001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-269-2250
Provider Business Practice Location Address Fax Number:
787-269-2295
Provider Enumeration Date:
08/04/2006

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: 2085R0202X , with the licence number:  7493 , 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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