1558742957 NPI number — RAFAEL BERRIOS MARCANO GINECOLOGO, P.S.C

Table of content: (NPI 1558742957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558742957 NPI number — RAFAEL BERRIOS MARCANO GINECOLOGO, P.S.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAFAEL BERRIOS MARCANO GINECOLOGO, P.S.C
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:
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:
1558742957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 CALLE SANTA CRUZ
Provider Second Line Business Mailing Address:
INSTITUTO SAN PABLO OFICINA 510
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961-7041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-787-1088
Provider Business Mailing Address Fax Number:
787-786-3398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 CALLE SANTA CRUZ
Provider Second Line Business Practice Location Address:
INSTITUTO SAN PABLO OFICINA 510
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:
787-787-1088
Provider Business Practice Location Address Fax Number:
787-786-3398
Provider Enumeration Date:
06/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BERRIOS MARCANO
Authorized Official First Name:
RAFAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PROPIETARIO
Authorized Official Telephone Number:
787-787-1088

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  9426 , 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: 1861542243 . This is a "1861542243" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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