1417367681 NPI number — NANCY WILLIAMS MALTES PSC

Table of content: (NPI 1417367681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417367681 NPI number — NANCY WILLIAMS MALTES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANCY WILLIAMS MALTES PSC
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:
1417367681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00732-0038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-848-0405
Provider Business Mailing Address Fax Number:
787-290-3535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1128 AVE MUNOZ RIVERA
Provider Second Line Business Practice Location Address:
RPTO. UNIVERSITARIO
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-0643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-848-0405
Provider Business Practice Location Address Fax Number:
787-290-3535
Provider Enumeration Date:
04/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-848-0405

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  704 , 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: 7310078 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3099 . This is a "IMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660423616 . This is a "HUMANA GOLD PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 800218 . This is a "MMM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30579 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400305 . This is a "PREFERRED HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com