1578557435 NPI number — GLADYS SANDRA DELIZ-FIGUEROA M.D.

Table of content: GLADYS SANDRA DELIZ-FIGUEROA M.D. (NPI 1578557435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578557435 NPI number — GLADYS SANDRA DELIZ-FIGUEROA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELIZ-FIGUEROA
Provider First Name:
GLADYS
Provider Middle Name:
SANDRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1578557435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73 CALLE SANTA CRUZ
Provider Second Line Business Mailing Address:
EDIFICIO MEDICO SANTA CRUZ, SUITE 304
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961-6910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-269-3986
Provider Business Mailing Address Fax Number:
787-995-3775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73 CALLE SANTA CRUZ
Provider Second Line Business Practice Location Address:
EDIFICIO MEDICO SANTA CRUZ, SUITE 304
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-6910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-269-3986
Provider Business Practice Location Address Fax Number:
787-995-3775
Provider Enumeration Date:
09/07/2005

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: 208D00000X , with the licence number:  12079 , 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: 12079 . This is a "MEDICAL LICENCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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