1598413395 NPI number — RUSDALY CARABALLO ORENGO PHARMD

Table of content: RUSDALY CARABALLO ORENGO PHARMD (NPI 1598413395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598413395 NPI number — RUSDALY CARABALLO ORENGO PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARABALLO ORENGO
Provider First Name:
RUSDALY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
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:
1598413395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 5 BOX 7535
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAUCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-374-1428
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 315 KM 1.0 AVE. FLAMBOYANES
Provider Second Line Business Practice Location Address:
INTERSECCION AVE. 65 DE INFANTERIA
Provider Business Practice Location Address City Name:
LAJAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-254-8151
Provider Business Practice Location Address Fax Number:
787-899-2097
Provider Enumeration Date:
03/11/2022

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: 183500000X , with the licence number:  6558 , 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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