1508833104 NPI number — MRS. LUZ M ALICEA BERRIOS MD

Table of content: MRS. LUZ M ALICEA BERRIOS MD (NPI 1508833104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508833104 NPI number — MRS. LUZ M ALICEA BERRIOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALICEA BERRIOS
Provider First Name:
LUZ
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1508833104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1302 RIVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALATKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32177-5042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-328-0108
Provider Business Mailing Address Fax Number:
386-325-1086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 DUNN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-323-9600
Provider Business Practice Location Address Fax Number:
386-323-9695
Provider Enumeration Date:
03/02/2006

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: 208D00000X , with the licence number:  8391 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: ACN880 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 019698900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: IV081Z . This is a "FL M CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ACN880 . This is a "FLORIDA MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 8286 . This is a "CRUZ AZUL" identifier . This identifiers is of the category "OTHER".




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