1568565893 NPI number — DR. ROSANGELA L FERNANDEZ MEDERO MD

Table of content: DR. ROSANGELA L FERNANDEZ MEDERO MD (NPI 1568565893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568565893 NPI number — DR. ROSANGELA L FERNANDEZ MEDERO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ MEDERO
Provider First Name:
ROSANGELA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
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:
1568565893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HIMA PLAZA I SUITE 714
Provider Second Line Business Mailing Address:
100 AVE. MUNOZ MARIN
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-204-0800
Provider Business Mailing Address Fax Number:
939-204-0800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 AVE LUIS MUNOZ MARIN
Provider Second Line Business Practice Location Address:
HIMA PLAZA I SUITE 714
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-204-0800
Provider Business Practice Location Address Fax Number:
939-204-0818
Provider Enumeration Date:
09/05/2006

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: 207RC0200X , with the licence number:  13990 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 13990 , 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: 13990 . This is a "PR STATE LISCENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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