1487115689 NPI number — ARYAM EMMANUEL VELAZQUEZ DAVILA MA

Table of content: ARYAM EMMANUEL VELAZQUEZ DAVILA MA (NPI 1487115689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487115689 NPI number — ARYAM EMMANUEL VELAZQUEZ DAVILA MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VELAZQUEZ DAVILA
Provider First Name:
ARYAM
Provider Middle Name:
EMMANUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
M

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:
1487115689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P41 CALLE JOSSIE PEREZ
Provider Second Line Business Mailing Address:
URB VALLE TOLIMA
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-462-7268
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KM 1.5 PR 787
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CIDRA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-462-7268
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2019

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: 103T00000X , with the licence number:  6005 , 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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