1629081914 NPI number — DR. DELIA ELIZABETH FARRULLA DMD

Table of content: DR. DELIA ELIZABETH FARRULLA DMD (NPI 1629081914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629081914 NPI number — DR. DELIA ELIZABETH FARRULLA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRULLA
Provider First Name:
DELIA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1629081914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00954-1068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-870-2221
Provider Business Mailing Address Fax Number:
787-870-1136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 AVE. JARDINES DE TOA ALTA 1RST. ST.
Provider Second Line Business Practice Location Address:
RIO DEL PLATA MALL
Provider Business Practice Location Address City Name:
TOA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-870-2221
Provider Business Practice Location Address Fax Number:
787-870-1136
Provider Enumeration Date:
08/15/2006

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: 1223G0001X , with the licence number:  1853 , 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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