1497897623 NPI number — JOEL ESTRADA MANGUAL

Table of content: MR. JEFFREY LEE NEUBARTH MD (NPI 1477713071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497897623 NPI number — JOEL ESTRADA MANGUAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOEL ESTRADA MANGUAL
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:
1497897623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SABANERA DEL RIO
Provider Second Line Business Mailing Address:
CAMINO DE LOS LIRIOS # 353
Provider Business Mailing Address City Name:
GURABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 30-19
Provider Second Line Business Practice Location Address:
SUITE 200 CARIBBEAN CINEMAS
Provider Business Practice Location Address City Name:
LAS PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-733-8850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ESTRADA
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-733-8850

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1097 , 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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