1568712933 NPI number — MISS CORAL DEL MAR MARTINEZ SLP

Table of content: MISS CORAL DEL MAR MARTINEZ SLP (NPI 1568712933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568712933 NPI number — MISS CORAL DEL MAR MARTINEZ SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
CORAL
Provider Middle Name:
DEL MAR
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
SLP
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:
1568712933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 509
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NARANJITO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00719-0509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-371-5040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. SANCHEZ OSORIO -5H-5
Provider Second Line Business Practice Location Address:
VILLA FONTANA PARK
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00988-9719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-768-3320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2012

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: 235Z00000X , with the licence number:  3098 , 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)





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