1508869165 NPI number — DR. SERGIO RAFAEL MOURE-RODRIGUEZ M.D.

Table of content: DR. SERGIO RAFAEL MOURE-RODRIGUEZ M.D. (NPI 1508869165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508869165 NPI number — DR. SERGIO RAFAEL MOURE-RODRIGUEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOURE-RODRIGUEZ
Provider First Name:
SERGIO
Provider Middle Name:
RAFAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1508869165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3866
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00970-3866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-787-7191
Provider Business Mailing Address Fax Number:
787-786-3667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIF INSTITUTO SAN PABLO
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-7041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-787-7191
Provider Business Practice Location Address Fax Number:
787-786-3667
Provider Enumeration Date:
05/27/2005

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: 174400000X , with the licence number:  8128 , 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)

  • Identifier: 066345 . This is a "LA CRUZ AZUL DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 204040 . This is a "PREFERRED HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 29466 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 33-08128 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 960010 . This is a "HUMANA HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0116 . This is a "FIRST MEDICAL CARD SYSTEM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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