1457487308 NPI number — DR. MARIA IVELISSE BERRIOS DMD

Table of content: DR. MARIA IVELISSE BERRIOS DMD (NPI 1457487308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457487308 NPI number — DR. MARIA IVELISSE BERRIOS DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRIOS
Provider First Name:
MARIA
Provider Middle Name:
IVELISSE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1457487308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COND. VILLAS DEL SENORIAL W.CHURCHILL AVE.
Provider Second Line Business Mailing Address:
APT #811
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:
787-559-9121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WINSTON CHURCHILL AVENUE
Provider Second Line Business Practice Location Address:
APT 811 COND VILLAS DEL SENORIAL
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-6711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-559-9121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2007

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: 1223P0221X , with the licence number:  DN20312 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 2674 , 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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