1508271776 NPI number — MISS ANNIE MEDINA CASTRO LICENCIADA

Table of content: MISS ANNIE MEDINA CASTRO LICENCIADA (NPI 1508271776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508271776 NPI number — MISS ANNIE MEDINA CASTRO LICENCIADA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDINA CASTRO
Provider First Name:
ANNIE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LICENCIADA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEDINA CASTRO
Provider Other First Name:
ANNIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICENCIADA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508271776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NUM 43 CALLE 9A BLOQ 23
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00985-5414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-877-0794
Provider Business Mailing Address Fax Number:
787-272-8796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COND CENTRO PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-480-2783
Provider Business Practice Location Address Fax Number:
787-274-8796
Provider Enumeration Date:
06/26/2014

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: 133NN1002X , with the licence number:  938 , 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)





Copyright © 2007-2024 www.npivalidator.com